
Adriamycin

Doxorubicin hydrochloride, or Adriamycin, belongs to the general group of drugs known as anthracyclines. It has FDA approval for use in treating cancer. Doxorubicin disrupts the growth of cancer cells, which are then destroyed.
Leiomyosarcoma response to doxorubicin [Adriamycin] including stable disease, is probably less than 50%.  The median length of the remission or stability often being measured in a handful of months.  Combinations of chemotherapy agents usually did not perform any better in terms of survival time than the individual agents themselves used separately.

Doxorubicin [Adriamycin] is exceedingly toxic and it is especially cardiotoxic. Because of the damage it does to cardiac muscle tissue, there is a lifetime personal limit of doxorubicin. Patients who are treated with doxorubicin [Adriamycin] need to have a MUGA scan or ultrasound ejection fraction done before treatment is started, and should be followed up with MUGA scans, or ejection fractions, to monitor for cardiac toxicity.

Doxorubicin [Adriamycin] also damages bone marrow cells, and Neupogen or Procrit may be necessary. Blood counts will be done before each dose is given. Doxorubicin can cause a decrease in the white blood cell count, especially 10-14 days after the drug is given. This can increase the risk of getting an infection. Report fevers of 100.5 F or higher, or signs of infection such as pain on passing urine, cough, and bringing up sputum to the doctor immediately.  Doxorubicin can cause a decrease in the platelet count. This can increase the risk of bleeding. DO NOT take any aspirin or aspirin-containing medicines. Report unusual bruising, or bleeding such as nosebleeds, bleeding of gums when brushing teeth, or black, tarry stools.

Doxorubicin can cause radiation recall, which means it can "recall" damage from prior radiation therapy. Let your doctor or nurse know if skin gets red in areas where radiation treatment was given previously.

Doxorubicin can cause severe nausea and vomiting. If this side effect occurs, medication to control it is available.

Doxorubicin is given intravenously. If the drug accidentally leaks out of the vein where it is given, it WILL damage the tissue and cause scarring and pain. Tell the nurse right away if there is redness, pain, or swelling at the place of injection.

Neuropathy [nerve pain or tingling] might be helped with extra vitamin B6, or other B Vitamins. Other agents are sometimes used. Do ask your doctor.

 A rash might come from tight fitting clothes, collars, shoes, underwear [women should not wear bras]. Do not use cortisone cream or Benadryl for the rash, but Nivea or Eucerin is recommended. ALWAYS check with your doctor.

Getting a wig before starting treatment may make it easier to deal with hair loss. Talk to the nurse or doctor about this. If  insurance does not cover it, there may be other resources available to help. Hair loss is temporary, and  hair will grow back after treatment. There is sometimes considerable pain with the hair loss, as the hair is lost. Note: After hair loss your head will be cold.


<b>Before taking this drug, notify your doctor of any of the following:</b>

a. If you are pregnant, breastfeeding or planning children in the future, inform your doctor of this before treatment. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Men and women who are taking this drug need to use some kind of birth control. However, do not use oral contraceptives without checking with your doctor.

b. If you are thinking about wanting to have children in the future, be sure to discuss this with your doctor. Many chemotherapy drugs can cause sterility.

c. If you have any of the following medical problems: chickenpox or exposure to chickenpox, gout, heart disease, congestive heart failure, shingles, kidney stones, liver disease.

d. If you are taking any other prescription or over-the-counter drugs, including vitamins and herbals. Your prescription and nonprescription medications may interact with other drugs, causing a harmful effect. Certain foods or alcohol can also interact with drug products. Never begin taking a new medication, prescription or nonprescription, without asking your doctor or nurse if it will interact with alcohol, foods or other medications. Some drug products can cause drowsiness and may affect activities such as driving.

While you are being treated with doxorubicin, and after you stop treatment, do not have any immunizations (vaccinations) without your doctor's okay. Try to avoid contact with people who have recently taken the oral polio vaccine. Check with your doctor about this.

<b>Side Effects: </b>

<b>Bone Marrow</b> [Decreased white blood cell count with increased risk of infection. Decreased platelet count with increased risk of bleeding. Decreased red blood cell count with increased fatigue.] Milder opportunistic infections such as thrush, vaginal candidiasis, and fungal infections of the nails are common.

<b>Digestive System</b>. [Loss of appetite. Sores in mouth or on lips. Nausea. Vomiting.] 

<b>Fatigue.

Skin/Hair/Nails</b>  [Darkening of nail beds and skin creases of hands. Hair loss, occasionally with considerable pain until it all falls out. Radiation recall skin changes]

<b>Heart</b> [Temporary changes in electrocardiogram (EKG). Irregular heartbeat. Permanent Heart damage with congestive heart failure.]

<b>Reproductive</b> [Fetal abnormalities if taken while pregnant or if becoming pregnant while on this drug] 


<b>Letter from a previous User:</b>

1) Leakage at the point of infusion MUST be avoided. Even excessive local  tingling should be regarded as suspicious. After one dodgy infusion my wife's arm was sore for 2 months - only 1 out of 6 though. 

2) Try very hard to alter the site of infusion (e.g. left arm, right arm). You need to allow the veins the maximum time to recover. Personally I think it should be given as high up the arm as possible i.e. in the largest vein. The procedure here is to use one of the small veins of the hand for all chemo. Unfortunately, my wife has very bad veins so its very difficult to find new ones - we should have pushed for a port. [There are complications with ports, too. Ed.]

3) I haven't heard of anyone in the UK being offered MUGA (admittedly limited experience), but unless you really had a massive tumor reduction after 6 doses, then I personally wouldn't consider more. 

4) The figures I found (can't remember where) reported a very low level of heart problems (less than 1% from memory) with 6 doses, rising to 20% (again from memory) with 10. 

5) This is a very toxic drug - very hard on the system, hits WBC levels very hard and also makes you very nauseated. Zofran helps this. My view - it's worth trying - you might be lucky - but unless you have a good reduction after 4 doses, try something else.  Jim.   


<b>Another Letter from a previous AIM user</b> [AIM is doxorubicin, ifosfamide, mesna]:

 In answer to your question about 'What difference would having read your research made with my taking AIM?'   
 I took AIM after my second tumor was removed and there were no metastases.  I'm not sure that was an informed and wise decision given LMS tumor resistance to chemo and the lasting damage to the body from chemo.  I had high dose AIM.  I knew about tumor resistance, but not about the permanent damage to the body. 
