Doxorubicin belongs to a family of chemotherapy drugs that are commonly used to treat leukemia, non-Hodgkin's lymphoma and cancers of the breast, lung and prostate. Marketed under the names Adriamycin and Doxil, doxorubicin is an antibiotic that combats cancer cells by preventing them from multiplying. Like many drugs of this type, however, it also disrupts the growth of normal cells in the body. As a result, serious side effects can occur even months or years after the patient stops taking the medicine.
Injection Site Reactions
Doxorubicin is usually injected into a vein in the patient's arm or sometimes through an access port that has been surgically implanted in the chest or upper arm. The harsh chemical properties of doxorubicin may cause hives, redness, itching or a stinging sensation at the site of the infusion. These symptoms can appear during the transfusion or several days or weeks later. A study published in "Oncology Nursing Forum" in 1990 analyzed 539 cases of these reactions, which are also known as flares. None of the reactions were severe, and 86 percent resolved within 45 minutes. In rare cases, pain may increase, and the skin may become discolored or blistered.
Nausea and Vomiting
Nausea and vomiting are common side effects of doxorubicin and other chemotherapy drugs that patients may be receiving at the same time. Chemotherapy-related nausea may occur within the first 18 to 24 hours after infusion, or it may be delayed for two or more days. In a four-year study conducted at the University of Rochester Cancer Center, 86 percent of 169 patients receiving doxorubicin had moderate or severe nausea during the first cycle of treatment. Approximately 83 percent of these patients reported that their nausea worsened two to five days after treatment. Nausea and vomiting episodes were somewhat less severe in later cycles of therapy.
Mouth Sores
Doxorubicin frequently produces painful ulcer-like sores inside the mouth and over the tongue, which can interfere with the patient's ability to eat and swallow some foods and beverages. These sores, also called mucositis, are more likely in patients receiving doxorubicin after a course of radiation therapy--such as those undergoing treatment for thyroid cancer. According to the Medical College of Wisconsin, 41 percent of patients who receive combined chemotherapy and radiation to the head or neck will have severe mucositis that requires prescription pain relief.
Hair Loss
Total loss of hair, known as alopecia, is a side effect to be expected with doxorubicin treatment. In a paper published in 2007 in the "Journal of Investigative Dermatology," lead researcher Dr. Yasuyuki Amoh described how doxorubicin disrupts the network of vessels supplying blood to hair follicles. This effect seems to be temporary, however, because hair growth usually returns to normal after patients finish chemotherapy.
Late Effects: Heart Failure and Leukemia
Doxorubicin administered in large doses can injure the heart muscle. The National Cancer Institute reports that patients who have received doxorubicin, particularly in high doses or for long periods, have been found to be at increased risk for heart failure during or after therapy. Women seem to be at higher risk, as do patients who received the drug for childhood cancers. Doxorubicin has also been linked to abnormalities in blood cells that result in acute promyelocytic leukemia. This blood cancer develops in approximately 1 percent of cancer survivors within two to seven years after completing chemotherapy.
References
- "Annals of Oncology": Extravasation: A Dreaded Complication of Chemotherapy
- "Oncology Nursing Forum": Doxorubicin-Associated Flare Reactions; Curran CF; 1990
- "Cancer": Nausea and Emesis Remain Significant Problems of Chemotherapy Despite Prophylaxis
- Medical College of Wisconsin: Oral Mucositis Diagnosis and Assessment
- "Journal of Investigative Dermatology": Chemotherapy Targets the Hair-Follicle Vascular Network but Not the Stem Cells
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