Adriamycin (Doxorubicin) Chemotherapy for Breast Cancer

Adriamycin (doxorubicin) is a type of chemotherapy medication used to treat many types of cancer. It is an often-used medication for breast cancer treatment, typically given in combination with other chemotherapy medications. 

It is made from a bacterium called Streptomyces peucetius. It works to kill cancer cells in two ways, by damaging the DNA, which kills the cells, and by blocking a pathway the cells use to fix themselves.

This article will review the uses of Adriamycin, as well as how it is given, the potential side effects, interactions, and things to know before and after treatment. 

Adriamycin and Breast Cancer

Adriamycin can be used for multiple types of cancer, but it's very effective in treating breast cancer. In this way, Adriamycin can help with:

• Breast cancer that has spread into nearby lymph nodes
• Metastatic breast cancer, in which breast cancer has spread into other areas of the body

Adriamycin is often combined with other chemotherapy medications to treat breast cancer.

Other Indications

Other cancers Adriamycin can treat include:

• Ovarian cancer
• Bladder cancer
• Sarcoma of bone and soft tissue
• Thyroid cancer
• Metastatic stomach cancer
• Neuroblastoma (develops from immature nerve cells in several areas of the body)
• Hodgkin's lymphoma and non-Hodgkin's lymphoma (cancers of the lymphatic system)
• Acute lymphoblastic leukemia/acute myeloblastic leukemia (blood and bone marrow cancers)
• Wilms' tumors (kidney tumors, primarily in children)
• Kaposi's sarcoma (cancer in the lining of blood vessels and lymph vessels)
  

Dosage and Administration

Adriamycin is given by injection. The drug is red in color and comes in a syringe, which will attach to catheter tubing. The infusion nurse will slowly push on the syringe's plunger to administer the chemotherapy into the vein.

The dosage and how often Adriamycin is given depends on the type of cancer being treated and if any other chemotherapy medications will be given as well.

Lifetime cumulative doses of Adriamycin above 550 mg/m2 (for 21 day cycles) are associated with an increased risk of cardiomyopathy and are contraindicated.

Side Effects and Risks

Side effects are common, though symptoms such as nausea and vomiting are often well controlled with preventive medications.

Side effects may include:

• Red-colored urine for two days after treatment (due to the drug's color, not bleeding)
• Hair loss or thin, brittle hair
• Nausea
• Vomiting
• Diarrhea
• Fatigue
• Mucositis (irritated mucous membrane in your mouth, stomach, and digestive tract)
• Amenorrhea (monthly menstrual cycle stops)
• Changes in nails

There are a number of more severe side effects associated with Adriamycin, including:

• Allergic reaction
• Harm to a fetus if you become pregnant during treatment
• Possible future infertility
• Low white blood counts and greater risk of infection
• Chemotherapy-induced anemia (low red blood cell count)
• Thrombocytopenia (low platelet count)
• Heart muscle damage
• Skin damage (can happen if the fluid leaks out and into your skin during infusion, called extravasation; talk to your oncologist about any redness, rashes, or tenderness near the infusion site)

Some of these risks, such as low blood counts (chemotherapy-induced neutropenia in particular), are common, and the oncologist may recommend a shot of Neulasta (pegfilgrastim), a drug to raise the white blood cell count, the day after the infusion.

Contraindications

The following drugs shouldn't be used along with Adriamycin because of potentially serious interactions:

• Gilotrif (afatinib)
• Erleada (apalutamide)
• Pradaxa (dabigatran)
• Visimpro (dacomitinib)
• Ferriprox (deferiprone)
• Savasysa (edoxaban)
• Balversa (erdafitinib)
• Zydelig (idelalisib)
• Sporanox (itraconazole)
• Serzone (nefazodone)
• Ofev (nintedanib)
• Kepivance (palifermin)
• Pomalyst (pomalidomide)
• Epclusa (sofosbuvir/velpatasvir)
• Xeljanz (tofacitinib)
• Herceptin (trastuzumab)

The list of drugs that require close monitoring when combined with Adriamycin is extensive. Be sure you discuss everything you're taking—including over-the-counter drugs and nutritional supplements—with your healthcare provider. It never hurts to double-check with your pharmacist either.

People with the following conditions shouldn't be given this drug, or should be closely monitored while on it:

• Severe liver disease
• Severe myocardial insufficiency
• Recent myocardial infarction (blood flow to the heart is blocked in the previous four to six weeks)
• Severe, persistent, drug-induced myelosuppression (decreased bone marrow activity)
• Pregnancy

Before Treatment

Because this drug can cause heart problems, you should have a MUGA (multigated acquisition) scan, echocardiogram, or heart health evaluation done before starting treatment. This baseline exam will be used to compare with your heart function during and after treatment. Other tests for kidney and liver function may also be needed.

During Treatment

Your healthcare provider will discuss what you need to do before and during Adriamycin treatment to ensure the infusion is as safe as possible.

It's important to:

• Use reliable birth control and avoid pregnancy. Adriamycin can cause birth defects.
• Drink lots of fluids, especially water, to flush your kidneys and bladder.
• Avoid drinking alcohol and caffeine as these have a dehydrating effect that can dry out your tissues.

When to Call Your Healthcare Provider

If you have any of these symptoms while taking Adriamycin, call your healthcare provider:

• Fever of 100.5 degrees or higher
• Pain or redness at your injection site
• Bloody urine
• Unusual bruises or persistent bleeding
• Persistent cough, sore throat, shortness of breath
• Allergic symptoms, chest tightness, swelling of feet or ankles, rash, swollen throat or tongue

Summary

Adriamycin is a type of chemotherapy, which is used in combination with other chemotherapy medications to treat breast cancer. It can also be used to treat other cancers, such as ovarian cancer, sarcoma, and neuroblastoma.

Side effects of Adriamycin include nausea, vomiting, hair loss, mouth sores, and fatigue. It also may cause the heart muscle to weaken, so the amount of medication someone can get is limited.

A Word From Verywell

Between its red color and potential for serious complications, using Adriamycin may make you take pause. That said, it is very effective in reducing the risk of recurrence in earl- stage breast cancer, especially tumors that are node positive. Be sure to weigh the pros and cons of this medication with your healthcare provider and give all your treatment decisions careful consideration.