Doxorubicin (Adriamycin)

==General information==
Class/mechanism: Anthracycline; binds and intercalates into DNA, inhibiting nucleotide replication and DNA/RNA polymerase activity. Intercalation of DNA triggers DNA cleavage via topoisomerase II. Toxic effects on organs may be related to cell membrane lipid binding activities; enzymatic electron reduction of doxorubicin creates reactive species, e.g. hydroxyl free radicals OH-, which has been implicated in cardiotoxicity by means of Cu (II) and Fe (III) reduction.Doxorubicin (Adriamycin) package insert Doxorubicin (Adriamycin) package insert (locally hosted backup)
Route: IV
Extravasation: vesicant
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias or the prescribing information. 
==Diseases for which it is established (work in progress)==
*Acute lymphoblastic leukemia (FDA)
**B-cell acute lymphoblastic leukemia
*Bladder cancer (FDA)
*Breast cancer (FDA)
*Hepatocellular carcinoma
*Lymphoma (PMDA)
**Anaplastic large cell lymphoma
**Burkitt lymphoma
**Classical Hodgkin lymphoma (FDA)
**Diffuse large B-cell lymphoma
**High-grade B-cell lymphoma
**HIV-associated lymphoma
**Hodgkin lymphoma, nodular lymphocyte-predominant
**Indolent lymphoma
***Follicular lymphoma
**Mantle cell lymphoma
**Mediastinal gray-zone lymphoma
**Post-transplant lymphoproliferative disorder
**Peripheral T-cell lymphoma
**Primary mediastinal B-cell lymphoma
**Transformed lymphoma
*Neuroblastoma (FDA)
*Osteosarcoma
*Soft tissue sarcoma (FDA)
*Wilms tumor (FDA)
==Diseases for which it is used==
*Adrenocortical carcinoma
*Adult T-cell leukemia-lymphoma
*Cutaneous basal cell carcinoma
*Cutaneous squamous cell carcinoma
*Endometrial cancer
*Ewing sarcoma
*Hepatoblastoma
*Kaposi sarcoma
*Malignant pleural mesothelioma
*Multiple myeloma
*Pancreatic NET
*Rhabdomyosarcoma
*Sarcomatoid renal cell carcinoma
*Thymoma
*Urothelial carcinoma
==Diseases for which it was used==
*Acute myeloid leukemia (FDA)
*Chronic lymphocytic leukemia
*Gastric cancer (FDA)
*Non-small cell lung cancer
*Ovarian cancer (FDA)
*Prostate cancer
*Small cell lung cancer (FDA)
*Testicular cancer
==Patient drug information==
*Doxorubicin (Adriamycin) patient drug information (Chemocare)Doxorubicin (Adriamycin) patient drug information (Chemocare)
*Doxorubicin (Adriamycin) package insert page 1 
*Doxorubicin (Adriamycin) patient drug information (UpToDate)Doxorubicin (Adriamycin) patient drug information (UpToDate)
==History of changes in FDA indication==
* 1974-08-07: Initial FDA approval
* 2003-05-08: Earliest date with label information at Drugs @ FDA: "Doxorubicin has been used successfully to produce regression in disseminated neoplastic conditions such as acute lymphoblastic leukemia, acute myeloblastic leukemia, Wilms’ tumor, neuroblastoma, soft tissue and bone sarcomas, breast carcinoma, ovarian carcinoma, transitional cell bladder carcinoma, thyroid carcinoma, gastric carcinoma, Hodgkin’s disease, malignant lymphoma and bronchogenic carcinoma in which the small cell histologic type is the most responsive compared to other cell types. (No supporting studies are cited)
* Uncertain date: Doxorubicin is also indicated for use as a component of adjuvant therapy in women with evidence of axillary lymph node involvement following resection of primary breast cancer. (Based on EBCTCG 1998 meta-analysis)
==History of changes in EMA indication==
*1996-06-21: EURD
==History of changes in PMDA indication==
*2014-12-18: Revised indication and a new dosage for the relief of symptoms of malignant lymphoma.
==Also known as==
*Code name: FI-106
*Generic names: ADM, doxorubicin hydrochloride, hydroxydaunorubicin
*Brand names:
Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms
Adriablastina	Adriacept 	Adriacin 	Adriamycin 	Adriamycine 	Adriblastin	Adriblastina	Adriblastine
Adricept 	Adricin 	Adrim 	Adrimedac 	Adrosal 	Antraciclin	Biorrub 	Biorubina
Cadria 	Carcinocin	Cloridrato DE	Doxorrubicina Colhidrol	Deldoxin 	Dicladox 	Dobicin 	Dobixin
Doxo 	Doxobin 	Doxo Cell 	Doxocris 	Doxokebir 	Doxolem 	Doxonolver 	Doxor
Doxorrubicina	Doxoruben 	Doxorubicina 	Doxorubicine 	Doxorubicinum	Doxorubin 	Doxotec 	Doxtie
Duxocin 	Evacet 	Farmiblastina	Fauldoxo 	Flavicina 	Ifadox 	Kemodoxa 	Lyphidox
Nagun 	Neoxane 	Nuaze 	Oncodria 	Onkodox 	Onkostatil 	Pallagicin 	Ranxas
Rastocin 	Ribodoxo 	Roxorin 	Rubex 	Varidoxo 	Zodox 	 	
==References==
#Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group. Lancet. 1998 Sep 19;352(9132):930-42. link to original article EuroPMC
Category:Drugs
Category:Intra-arterial medications
Category:Intravenous medications
Category:Intravesical medications
Category:Vesicant
Category:Anthracyclines
Category:Topoisomerase II inhibitors
Category:Adrenocortical carcinoma medications
Category:Adult T-cell leukemia-lymphoma medications
Category:Anaplastic large cell lymphoma medications
Category:B-cell acute lymphoblastic leukemia medications
Category:Bladder cancer medications
Category:Breast cancer medications
Category:Burkitt lymphoma medications
Category:Classical Hodgkin lymphoma medications
Category:Cutaneous basal cell carcinoma medications
Category:Cutaneous squamous cell carcinoma medications
Category:Diffuse large B-cell lymphoma medications
Category:Endometrial cancer medications
Category:Ewing sarcoma medications 
Category:Follicular lymphoma medications
Category:Hepatoblastoma medications
Category:Hepatocellular carcinoma medications
Category:High-grade B-cell lymphoma medications
Category:HIV-associated lymphoma medications
Category:Hodgkin lymphoma, nodular lymphocyte-predominant medications
Category:Indolent lymphoma medications
Category:Kaposi sarcoma medications
Category:Malignant pleural mesothelioma medications
Category:Mantle cell lymphoma medications
Category:Mediastinal gray-zone lymphoma medications
Category:Multiple myeloma medications
Category:Neuroblastoma medications
Category:Osteosarcoma medications
Category:Pancreatic NET medications
Category:Peripheral T-cell lymphoma medications
Category:Post-transplant lymphoproliferative disorder medications
Category:Primary mediastinal B-cell lymphoma medications
Category:Rhabdomyosarcoma medications
Category:Sarcomatoid renal cell carcinoma medications
Category:Soft tissue sarcoma medications
Category:Thymoma medications
Category:Transformed lymphoma medications
Category:Urothelial carcinoma medications
*Category:Acute myeloid leukemia medications (historic)
*Category:Chronic lymphocytic leukemia medications (historic)
*Category:Gastric cancer medications (historic)
*Category:Non-small cell lung cancer medications (historic)
*Category:Ovarian cancer medications (historic)
*Category:Prostate cancer medications (historic)
*Category:Small cell lung cancer medications (historic)
*Category:Testicular cancer medications (historic)
Category:FDA approved in 1974
Category:EMA approved in 1996
Category:WHO Essential Cancer Medicine