<b>DOXIL</b>

Doxil is a different form of doxorubicin, the surface area is protected by liposomes. Conventional doxorubicin is significantly bound to tissue and plasma proteins whereas the liposomal product is confined mostly to the vascular fluid and does not bind to plasma proteins. Doxil is supposed to penetrate the tumor better, and be less amenable to metabolic degradation.
It seems that Adriamycin is first line treatment IF your body is healthy enough to try it, and Doxil is considered for clinical trials, and for those who have significant heart disease or who wish a better side effect profile.

This the difference in the dosing regimes that the PDR recommends:
Adriamycin: 60-75 mg/m2 as a single injection every 21 days. Alternatively, 30 mg/m2 for 3 successive days q 4 weeks, or 20 mg/m2 weekly. Do not exceed a total dose of 550 mg/m2 This is a lifetime dose and that is another reason someone might receive Doxil.

Doxil: 20 mg/m2 over 30 min once every 3 weeks, as long as the client responds satisfactorily and tolerates the drug. Each cancer will have a different recommended dose so this is ONLY a recommendation. Usually in sarcomas you will see VERY HIGH dose therapy of both. The Marsden 2001 study that showed equivalence with Adriamycin had a Doxil dosage of 50 mg/m2 every 4 weeks.

There is a big difference in the incidence of side effects between the two medicines. For most people the Doxil side effects are less. You should be careful about the initial choice that is made for you, especially if you are being treated in a more rural area. Accidental substitution of Doxil for doxorubicin HCl has resulted in severe side effects. Do not substitute. The use of Doxil should be limited to physicians experienced in the use of cancer chemotherapeutic agents.

In clinical trials, the most common side effects reported with Doxil therapy included reduced red blood cell count (anemia), reduced white blood cell count (neutropenia), nausea, hand-foot syndrome, soreness of the mouth (stomatitis), weakness, vomiting, rash, mild hair loss, constipation, appetite loss, diarrhea, and tiredness. Some patients experienced infusion-related reactions and skin reactions. Hand-foot syndrome, also known as Palmar-plantar erthrodysesthesia (PPE), is characterized by symptoms of swelling, pain, redness and, for some patients, peeling of the skin on the hands and feet; in 17 percent of patients, these symptoms were moderate to severe. 
Some severe heart-related side effects have been reported, and there is the possibility of severe bone marrow suppression. These are serious, potentially PERMANENT damages. Dosage should be reduced in patients with impaired liver function.

Experience with Doxil at high cumulative doses is too limited to have established its effects on the myocardium. Therefore, it should be assumed that Doxil will have myocardial toxicity similar to conventional formulations of doxorubicin HCl. Doxil should be administered to patients with a history of cardiovascular disease only when the benefit outweighs the risk. 
