Liposomal Doxorubicin (Pegylated) — Drug Monograph

Brand names: Doxil, Caelyx

Drug class: Anthracycline

Mechanism of Action

Doxorubicin encapsulated in pegylated liposomes. PEG coating ("stealth" liposomes) evades the reticuloendothelial system, prolonging circulation. Preferential accumulation in tumors via the enhanced permeability and retention (EPR) effect due to leaky tumor vasculature. Same intracellular mechanism as conventional doxorubicin.

FDA Indications

• AIDS-related Kaposi sarcoma
• Ovarian cancer — after platinum-based therapy failure
• Multiple myeloma — in combination with bortezomib (after at least one prior therapy)

Common Side Effects

• Hand-foot syndrome (palmar-plantar erythrodysesthesia) — most characteristic toxicity
• Mucositis/stomatitis
• Myelosuppression (less than conventional doxorubicin)
• Nausea (less than doxorubicin)
• Alopecia (less pronounced)
• Infusion-related reactions (flushing, dyspnea — often during first infusion)

Clinical Pearl

Liposomal doxorubicin is NOT interchangeable with conventional doxorubicin — different doses, schedules, and toxicity profiles. The infusion reaction during first infusion is not a true allergy; slow the infusion rate and premedicate. Palmar-plantar erythrodysesthesia (HFS) is the dose-limiting toxicity — pyridoxine (vitamin B6) is used by some clinicians but has no consistent RCT evidence.

Related Therapies & Mechanisms

• Doxorubicin (Adriamycin) — Anthracycline · Breast
• Epirubicin (Ellence) — Anthracycline · Breast
• Carboplatin (Paraplatin) — Breast
• Cyclophosphamide (Cytoxan) — Breast