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The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
Doxorubicin is an anthracycline from a soil bacterium that poisons topoisomerase II, intercalates into DNA and generates free radicals; its cardiotoxicity arises through topoisomerase II beta in cardiomyocytes. Approved in 1974, it is the backbone of AIM and doxorubicin-ifosfamide (sarcoma), CHOP and R-CHOP (lymphoma), ABVD and AVD (Hodgkin lymphoma), AC and EC (breast) and MAP (osteosarcoma). Cumulative cardiotoxicity above about 400 to 450 mg/m2 limits use, with cardiomyopathy in around 5% at 400 mg/m2 and rising steeply above 550 mg/m2, so serial echocardiography is required; dexrazoxane and liposomal formulations mitigate the risk. Neutropenia, alopecia and nausea are expected with every cycle. It was also the payload of early ADC attempts. This is the red chemotherapy that still anchors many curative regimens, rationed by what the heart can take over a lifetime.
Topoisomerase II poisoning and DNA intercalation with free-radical generation; cardiotoxicity via topoisomerase IIβ in cardiomyocytes.
1.Intercalates between DNA base pairs
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Generic.
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE search: doxorubicin. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
| Region | Year | Indication |
|---|---|---|
| US | 1974 | Broad: sarcomas, lymphomas, leukaemias, breast, and other solid tumours |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia single-agent 75 mg/m2 (ANNOUNCE control arm) | - | 60% |
| Cardiomyopathy (cumulative) at 400 mg/m2; rises steeply above 550 mg/m2 | 5% | - |
| Alopecia | 90% | - |
| Nausea/vomiting | 60% | - |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
Read for the class this product belongs to (anthracyclines) unless the answer names the product. Population figures from the cohorts named, not a prediction for one person. Blank where no source gives a recovery figure.
| Country | Reimbursement | List price | Assistance |
|---|---|---|---|
| United Statesgeneric | - | Generic; low cost | - |
List prices are manufacturer or Medicare figures where publicly disclosed; net prices after rebates are usually lower. Reimbursement changes; check the payer.
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The authors' conclusion is that ibrutinib-rituximab should be considered a new standard-of-care option for first-line treatment of older patients with mantle-cell lymphoma. The subgroup split means it is clearly better than R-CHOP and roughly equivalent to bendamustine-rituximab.
For fit younger patients treated in the intensive German tradition, BrECADD replaces escalated BEACOPP; how it compares with nivolumab-AVD from S1826 is the open question.
S1826 moved checkpoint blockade into first-line Hodgkin lymphoma and made N-AVD a preferred regimen for advanced disease in patients from adolescence to older age, while removing radiotherapy for most. It also showed the value of a single trial spanning paediatric and adult groups. Longer follow-up is needed for overall survival and late immune effects in young patients.
Doxorubicin-trabectedin is a first-line standard for fit patients with metastatic leiomyosarcoma, one of the few histology-specific first-line regimens in sarcoma.
POLARIX gave the first new first-line standard for DLBCL since rituximab was added to CHOP, and pola-R-CHP is now approved and widely used, especially in higher-risk or ABC-type disease. The gain is modest and survival is unchanged, so many clinicians still use R-CHOP in lower-risk or GCB-type patients. Cost and subgroup uncertainty drive ongoing debate.
Nodular lymphocyte-predominant Hodgkin lymphoma is rarely fatal when treated with standard Hodgkin lymphoma protocols, so the goal for most patients is to give less treatment, not more; the minority with advanced or variant disease still need better options.
R-CHOP remains the standard first-line regimen for diffuse large B-cell lymphoma. The trial is also the clearest lesson in the disease about adopting a regimen on single-arm data: dose-adjusted EPOCH-R had been used widely for a decade before this comparison existed.
Four cycles rather than six for young patients with limited-stage, low-risk aggressive B-cell lymphoma. The saving is two cycles of anthracycline and vincristine in people who will live for decades afterwards.
Query for this drug: (TITLE:"Doxorubicin" OR ABSTRACT:"Doxorubicin" OR TITLE:"Adriamycin" OR ABSTRACT:"Adriamycin") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Doxorubicin, not a curated reading list.
Shares A Study of HDM2005 in Combination With Standard of Care in Patients With Diffuse Large B-Cell Lymphoma, IFM 2006 prospective trial: bortezomib-based induction and transplantation for primary plasma cell leukaemia, Chemotherapy With or Without Trastuzumab After Surgery in Treating Women With Invasive Breast Cancer, Erythropoietin for Management of Anemia Caused by Chemotherapy.
Shares COG AREN0532, Erythropoietin for Management of Anemia Caused by Chemotherapy, Tucidinostat in Combination With CHOP in Newly Diagnosed Peripheral T-Cell Lymphoma With Follicular Helper of T Cell Phenotype, Wilms tumour risk markers (anaplasia, 1p/16q loss, 1q gain, SIOP and COG risk groups).
Shares A Study of HDM2005 in Combination With Standard of Care in Patients With Diffuse Large B-Cell Lymphoma, Chemotherapy With or Without Strontium-89 in Treating Patients With Prostate Cancer, Erythropoietin for Management of Anemia Caused by Chemotherapy, Tucidinostat in Combination With CHOP in Newly Diagnosed Peripheral T-Cell Lymphoma With Follicular Helper of T Cell Phenotype.
Shares FIRM-ACT: combination chemotherapy in advanced adrenocortical carcinoma, Clinical Study of XNW5004 Combined With CHOP/CHOEP in the Treatment of Untreated Peripheral T-Cell Lymphoma, EuroNet-PHL-C2, GHSG HD21: PET-guided BrECADD versus escalated BEACOPP in advanced-stage classical Hodgkin lymphoma.
Shares Erythropoietin for Management of Anemia Caused by Chemotherapy, A Phase III Trial Comparing Tisagenlecleucel to Standard of Care (SoC) in Adult Participants With r/r Follicular Lymphoma, Study of Axicabtagene Ciloleucel Versus Standard of Care Therapy in Participants With Relapsed/Refractory Follicular Lymphoma, HHV-8 (KSHV) status and LANA-1 immunohistochemistry.
Shares GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma, RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma, GHSG HD21: PET-guided BrECADD versus escalated BEACOPP in advanced-stage classical Hodgkin lymphoma, Four versus six cycles of CHOP chemotherapy in combination with six applications of rituximab in patients with aggressive B-cell lymphoma with favourable prognosis (FLYER).
Shares INT-0091 (Ewing sarcoma), MASCT-I Combined With Doxorubicin and Ifosfamide for First-line Treatment of Advanced Soft Tissue Sarcoma, EORTC 62012, Pleuropulmonary blastoma (types I, Ir, II and III).
Shares RAPID: PET-directed therapy for early-stage Hodgkin lymphoma, Long-term follow-up of nodular lymphocyte-predominant Hodgkin lymphoma treated in the GHSG HD7 to HD15 trials, A Study of Brentuximab Vedotin + Adriamycin, Vinblastine, and Dacarbazine in Pediatric Participants With Advanced Stage Newly Diagnosed Hodgkin Lymphoma, GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma.