Doxorubicin — Drug Monograph

Brand names: Adriamycin

Drug class: Anthracycline

Mechanism of Action

Intercalates into DNA base pairs, inhibiting topoisomerase II and preventing DNA uncoiling and strand relegation. Also generates free radicals (quinone reduction) causing lipid peroxidation and DNA strand breaks. Cardiotoxicity is mediated by iron-dependent free radical formation in cardiac myocytes (which have limited catalase activity).

FDA Indications

• Acute lymphoblastic leukemia (ALL)
• Acute myeloblastic leukemia (AML)
• Wilms tumor
• Neuroblastoma
• Soft tissue and bone sarcomas
• Breast carcinoma
• Ovarian carcinoma
• Transitional cell bladder carcinoma
• Thyroid carcinoma
• Hodgkin lymphoma
• Non-Hodgkin lymphoma
• Gastric carcinoma
• Small cell lung carcinoma

Common Side Effects

• Myelosuppression
• Alopecia (near-universal; reversible)
• Nausea and vomiting (high emetic risk)
• Mucositis/stomatitis
• Red discoloration of urine (warn patients)
• Amenorrhea
• Radiation recall reaction

Clinical Pearl

Dexrazoxane (Zinecard) is an iron chelator that provides cardioprotection from anthracyclines. It is FDA-approved for patients who have received ≥300 mg/m² of doxorubicin and need continued therapy. It was historically avoided in pediatric patients due to concerns about secondary malignancies and reduced efficacy — however, current data and AHA/COG guidelines now support its use in children receiving high cumulative doses.

Related Therapies & Mechanisms

• Cyclophosphamide (Cytoxan) — Breast
• Pembrolizumab (Keytruda) — Breast
• Bendamustine (Treanda) — Lymphoma
• Etoposide (VePesid) — Lymphoma