Cancer Breast Cancer Treatment Print Adriamycin (Doxorubicin) Chemotherapy for Breast Cancer "The Red Devil" is also known by the brand names Rubex and Doxil Medically reviewed by Medically reviewed by Doru Paul, MD on May 22, 2019 Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. Learn about our Medical Review Board Doru Paul, MD Written by Pam Stephan Updated on July 17, 2019 Breast Cancer Overview Symptoms Causes Diagnosis Treatment Coping Prevention In This Article Table of Contents Expand Uses Efficacy Dosage/Administration Side Effects/Risks Interactions/Contraindications Before Treatment During Treatment View All Adriamycin (doxorubicin)—also known by the trade names Rubex and Doxil—is a chemotherapy drug that can slow or stop the growth of cancer cells. Adriamycin is commonly used to treat both early stage and metastatic breast cancer, usually in combination with other drugs. More specifically, Adriamycin is a type of anthracycline antibiotic that is an anti-tumor drug and is made from the bacterium Streptomyces. It can be beneficial in cancer treatment because it can inhibit the activity of an enzyme called topoisomerase-II after entering cancer cells and inserting itself into the DNA structure. This action makes cells unable to reproduce themselves. However, Adriamycin also forms oxygen free radicals, which damage cell membranes and proteins. It is one of the chemotherapy drugs likely to cause hair loss, and can also cause heart damage for some people. "The Red Devil" Adriamycin is sometimes referred to by this nickname because the drug comes in the form of a red liquid, which is delivered intravenously. Uses In the context of breast cancer treatment, Adriamycin may be used for: Early-stage or node-positive breast cancerHER2-positive breast cancerMetastatic disease Adriamycin is sometimes combined with Cytoxan (cyclophosphamide) and/or 5-fluorouracil to make a cocktail of breast-cancer-fighting chemotherapy drugs. The newer "double-dose" therapy uses a combination of high dose Adriamycin and Cytoxan in combination. Other Indications This drug is also approved by the U.S. Food and Drug Administration (FDA) for the treatment of other cancers, including: Ovarian cancerBladder cancerSoft tissue cancerOsteogenic sarcomaSmall cell lung cancerThyroid cancerGastric cancersNeuroblastomaLymphomaLeukemiaWilms tumorsKaposi's sarcoma Efficacy Adriamycin is considered one of the preferred chemotherapy drugs for breast cancer. According to a 2017 review of studies on the pegylated liposomal form (PLD), a phase 2 clinical study suggested that, after six cycles of PLD in combination with other drugs, remission was achieved in 71 percent of people with locally advanced or recurrent breast cancer. Similar studies suggested a 74 percent remission rate. A 2014 study suggested that PLD along with Cytoxan (cyclophosphamide), Herceptin (trastuzumab), and Taxol (paclitaxel) for HER-2 positive locally advanced breast cancer achieved an effective rate of 83 percent. The 2017 review cited above reports that in metastatic breast cancer, which is significantly harder to treat, PLD has had clinical trial success rates ranging from about 36 percent to 54 percent, depending on the trial and the combination of drugs used. While effective, this medication does have a couple of factors working against it: Severe side effects (see below)Drug resistance Because of the side effects, many people can't take it and others may be scared to try it. The drug resistance means that it's not effective against some tumors. Liposomal and especially pegylated liposomal formulations appear to remain effective while lowering the risk of heart problems. In addition, researchers are looking at other formulations that may improve the safety profile and decrease drug resistance, as well as drugs and supplements to pair with Adriamycin that allow for a lower dosage. According to a 2015 study published in the journal Scientific Reports, these include: CurcuminInterferon-alphaQuercetinSelenocystineOcotillol To help the drug more effectively kill cancer cells, a form of sugar called methyl beta-cyclodextrin (MCD) appears to be effective due to several mechanisms of action, according to the Scientific Reports paper. Dosage and Administration Adriamycin is given by injection during a chemotherapy infusion. If the dose of Adriamycin that you are being given is very thick, it may be given as a "push" injection, rather than through an intravenous drip. The drug will be delivered in a large plastic syringe, which will be attached to your catheter tubing. Your infusion nurse will slowly depress the plunger manually to inject the Adriamycin into your vein. The adult dosage for breast cancer and several other forms of cancer is variable and can be any of the following: 60-75 mg/m(2) IV every 21 days60 mg/m(2) IV every 14 days40-60 mg/m(2) IV every 21-28 days20 mg/m(2) per week 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 hairNauseaVomitingDiarrheaFatigueMucositis (irritated mucous membrane in your mouth, stomach, and digestive tract)Amenorrhea (monthly menstrual cycle stops)Changes in nails (brittle or yellowed) There are a number of risks related to Adriamycin, including: Allergic reactionHarm to the fetus, if you become pregnant during treatmentPossible future infertilityLow blood counts and greater danger of infectionsChemotherapy-induced anemia (low red blood cell count)Thrombocytopenia (low platelet count)Heart damage, which is more common in womenSkin damage: This can happen if the fluid leaks out and into your skin during infusion (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 with double-dose therapy, your oncologist may recommend you receive a shot of Neulasta (pegfilgrastim), a drug to raise the white blood cell count, the day after your infusion. Others risks, such as heart damage, are much less common overall. Planning a Family? Because infertility is possible, women who may want to have a child after treatment should talk to their oncologist (and a fertility specialist) before beginning treatment. Interactions and Contraindications The following drugs shouldn't be used along with Adriamycin because of potentially serious interactions: Gilotrif (afatinib)Erleada (apalutamide)Padaxa (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 doctor. 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 diseaseSevere myocardial insufficiencyRecent myocardial infarction (the past four to six weeks)Severe, persistent, drug-induced myelosuppressionPregnancy Before Beginning Therapy Because this drug can cause heart problems, you should have a MUGa scan, LVEF (left ventricular failure) test, 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 doctor will talk about 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 contraception and avoid a pregnancy. Adriamycin can cause birth defects if given during the first trimester.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.Don't take aspirin, as it thins your blood. When to Call Your Doctor If you have any of these symptoms while taking Adriamycin, call your doctor: Fever of 100.5 degrees F or higherPain or redness at your injection siteBloody urine or reddish sweatUnusual bruises or persistent bleedingPersistent cough, sore throat, pneumoniaAllergic symptoms, such as shortness of breath, swelling of feet or ankles, rash, swollen throat or tongue Vaccine Considerations Live vaccines (e.g., FluMist, MMR, shingles vaccine) have the potential to cause an infection in people who are immunosuppressed, so they should not be used during chemotherapy. Killed vaccines don't pose this risk, but chemotherapy may render them ineffective. Speak to your oncologist about whether or not one might still be recommended for you. 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 early stage breast cancer, especially tumors that are node positive. Be sure to weigh the pros and cons of this medication with your doctor and give all your treatment decisions careful consideration. Coping With Hair Loss During Chemotherapy Was this page helpful? Thanks for your feedback! Get honest information, the latest research, and support for you or a loved one with breast cancer right to your inbox. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Xing M, Yan F, Yu S, Shen P. Efficacy and cardiotoxicity of liposomal doxorubicin-based chemotherapy in advanced breast cancer: A meta-analysis of ten randomized controlled trials.PLoS One. 2015 Jul 23;10(7):e0133569. doi: 10.1371/journal.pone.0133569. Tuxen MK, Cold S, Tange UB, Balslev E, Nielsen DL. Phase II study of neoadjuvant pegylated liposomal doxorubicin and cyclophosphamide +/- trastuzumab followed by docetaxel in locally advanced breast cancer.Acta Oncol. 2014 Oct;53(10):1440-5. doi: 10.3109/0284186X.2014.921727. Mohammad N, Singh SV, Malvi P, et al. Strategy to enhance efficacy of doxorubicin in solid tumor cells by methyl-β-cyclodextrin: Involvement of p53 and Fas receptor ligand complex.Sci Rep. 2015 Jul 7;5:11853. doi: 10.1038/srep11853. Additional Reading National Cancer Institute, "Doxorubicin Hydrochloride." Tuxen MK, Cold S, Tange UB, Balslev E, Nielsen DL. Phase II study of neoadjuvant pegylated liposomal doxorubicin and cyclophosphamide +/- trastuzumab followed by docetaxel in locally advanced breast cancer. Acta Oncol. 2014 Oct;53(10):1440-5. doi: 10.3109/0284186X.2014.921727. Continue Reading