Doxorubicin

Doxorubicin is a chemotherapy drug used to treat several types of cancer. In use since the 1970s, doxorubicin is manufactured by multiple companies and sold under various brand names. Doxorubicin, though approved by the U.S. Food and Drug Administration (FDA) to treat several types of cancer, is not approved to treat mesothelioma.

Although not officially approved for mesothelioma, doctors often prescribe doxorubicin for mesothelioma patients, particularly in combination with other drugs. Clinical trials are increasing understanding of the drug’s effectiveness. Doxorubicin has some serious risks and side effects. However, when carefully combined with other drugs, doxorubicin may prove very effective in the treatment of mesothelioma.

What is Doxorubicin?

Doxorubicin is the generic name of a drug used to treat several types of cancer. This drug is administered through intravenous injection and is used in combination with other drugs to increase efficacy. It is sold as a ready-made solution for injection, or as a powder that can be mixed to form a solution. Some brand names are Adriamycin, Rubex, and Doxil. Doxorubicin is currently manufactured by Teva Pharmaceuticals, Janssen Pharmaceuticals, Pfizer, and Bedford Laboratories.

In 1974, the first FDA approval for doxorubicin was awarded to Pharmacia and Upjohn. The FDA has since approved changes in dosing, generic forms by various pharmaceutical companies, and new uses proven to be effective and relatively safe.

How it Works

Doxorubicin is type of antibiotic classified as an anthracycline. This class of chemotherapeutic agents includes drugs derived from Streptomyces bacteria. Although they are antibiotics, they are useful in treating cancers. Because anthracyclines damage DNA, they prove effective in killing cancer cells. As with many chemotherapy drugs, this cell-killing effect is not limited to cancer. Healthy cells can also be destroyed by anthracyclines which produces unpleasant side effects.

Uses for Doxorubicin

FDA approval for doxorubicin includes specific types of cancer. Doctors may prescribe the drug for unapproved or “off label” uses, and they sometimes do so for mesothelioma. Doxorubicin has been approved for treatment of ovarian cancer after earlier treatment with a platinum-based drug has failed. Doxorubicin can also be used to treat multiple myeloma in combination with the drug bortezomib. It is also approved to treat Kaposi’s sarcoma related to AIDS after other chemotherapy combinations have failed. However, doxorubicin is not approved for treating any type of mesothelioma. In spite of this, it can be used for mesothelioma patients and has been used  in several clinical trials.

Side Effects

Because doxorubicin also kills non-cancerous cells, it can cause serious side effects. The most common side effects include fatigue, hair loss, dizziness, eye pain, discolored urine, and increased thirst. Other common side effects are weight loss, loss of appetite, nausea, vomiting, fever, diarrhea, constipation, skin rash, mouth sores, and anemia. This drug can also lead to a weakened immune system resulting in infection. Many of these side effects are common to all chemotherapy drugs.

Doxorubicin may also cause hand and foot syndrome, a skin reaction on the palms of the hands and the soles of the feet. This condition most commonly occurs a few weeks after starting chemotherapy. Symptoms of hand and foot syndrome include stinging in the hands or feet, cracked, dry, and peeling skin, thickened skin like a callus, redness, blistering, and swelling. Hand and foot syndrome can be painful and often restricts movement. Patients who experience this condition should report to their doctor and consult with a dermatologist.

Black Box Warning and Serious Risks

Doxorubicin may also cause more severe reactions. The FDA includes a black box warning, its most serious, for more severe side effects. The drug may leak into surrounding tissues at the injection site, causing serious damage as well as pain, itching, blisters, and sores.

Doxorubicin may also cause life-threatening heart problems, even years after treatment has concluded.  Potential heart problems include congestive heart failure and the risk increases with medicine dosage. Patients taking doxorubicin may also be susceptible to serious infections caused by suppression of blood cell production. This suppression could potentially affect the production of white blood cells in bone marrow. Doxorubicin may cause liver damage and increase the chance of developing leukemia. Doctors should monitor patients before, during, and after treatment for these serious problems. Some patients with existing heart, liver, or immune system impairments may not be eligible for treatment with doxorubicin.

Studies of Doxorubicin to Treat Mesothelioma

Doxorubicin has not been approved by the FDA to treat mesothelioma. However, this is influenced by the rarity of this particular type of cancer. Doctors and researchers have been trying doxorubicin with mesothelioma patients for years. Several studies indicate it may be a promising course of treatment.

Some studies are very small, including a case study of just one patient published in 2012. In this study, a man with pleural mesothelioma was given a combination of chemotherapy drugs that included a form of doxorubicin called pegylated liposomal doxorubicin hydrochloride. This form is thought to be absorbed less in healthy tissues, making it more specific to tumor cells. The patient was given this drug in combination with etoposide and paclitaxel. He responded well to treatment. In 2012, nine years after receiving the doxorubicin combination, the patient was still living. his is a major accomplishment for someone with mesothelioma.

In another study, 67 patients with peritoneal mesothelioma were given doxorubicin along with paclitaxel and cisplatin. Results were astounding, producing a median survival time of more than six years. One patient in the study survived 12 years. A smaller study confirmed these results by combining cisplatin with other chemotherapy drugs. The best results were seen with cisplatin combined with doxorubicin.

Mesothelioma is a difficult cancer to treat. Although doxorubicin is not approved for mesothelioma treatment, it shows incredible potential. Doxorubicin does have the potential to cause serious side effects. However, for patients with mesothelioma, these risks are often outweighed by the benefits.