Adriamycin: Red Devil Chemotherapy

Adriamycin (doxorubicin), also known as the "red devil" chemo drug, is a type of chemotherapy medication used to treat many types of cancer. The drug's nickname comes from its characteristic red color and because of the serious side effects it may cause. It is an often-used medication for breast cancer treatment, typically given in combination with other chemotherapy medications. 

It is made from a bacterium called Streptomyces peucetius. It works to kill cancer cells in two ways— by damaging the DNA, which kills the cells, and by blocking a pathway the cells use to fix themselves.

This article will review the uses of Adriamycin, how it is given, the potential side effects, interactions, and things to know before and after treatment. 

Red Devil Chemo and Breast Cancer

Adriamycin is particularly effective in treating breast cancer. Breast cancer cells are formerly healthy breast cells that have developed bad DNA. Adriamycin works by further damaging the DNA inside of those cells so that they cannot continue to make more copies of themselves.

It is commonly used:

• To reduce the risk of early-stage breast cancer from coming back after surgery
• Before surgery to shrink advanced-stage breast tumors
• To treat advanced-stage breast cancer

Adriamycin is often combined with other chemotherapy medications to treat breast cancer. It can help with:

• Breast cancer that has spread into nearby lymph nodes
• Metastatic breast cancer, in which breast cancer has spread into other areas of the body
  

Adriamycin is regarded as one of the strongest chemotherapy drugs ever developed and is able to kill cancer cells at every stage in their life cycle. It is not just used to treat breast cancer, but a wide variety of other cancers,

Other Types of Cancer Red Devil Chemo Treats

Adriamycin can be used for multiple types of cancer. In cases where adriamycin is effective against cancer cells, it will shrink cancerous tumors. Other cancers Adriamycin can treat include:

• Ovarian cancer
• Bladder cancer
• Metastatic sarcoma of bone and soft tissue
• Metastatic stomach cancer
• Metastatic thyroid cancer
• Metastatic neuroblastoma (develops from immature nerve cells in several areas of the body)
• Hodgkin's lymphoma and non-Hodgkin's lymphoma (cancers of the lymphatic system)
• Acute lymphoblastic leukemia/acute myeloblastic leukemia (blood and bone marrow cancers)
• Metastatic Wilms tumor (kidney tumors, primarily in children)
  

Dosage and Administration

Adriamycin is given by injection. The drug is red in color and comes in a syringe, which will attach to catheter tubing. The infusion nurse will slowly push on the syringe's plunger to administer the chemotherapy into the vein.

The dosage and how often Adriamycin is given depends on the type of cancer being treated and if any other chemotherapy medications will be given as well.

Lifetime cumulative doses of Adriamycin above 550 mg/m2 (for 21 day cycles) are associated with an increased risk of cardiomyopathy and are contraindicated.

Side Effects and Risks

Side effects are common, though symptoms such as nausea and vomiting are often well-controlled with preventive medications.

Side effects may include:

• Red-colored urine for two days after treatment (due to the drug's color, not bleeding)
• Hair loss (which may be total)
• Nausea
• Vomiting
• Fatigue
• Mouth sores
• Amenorrhea (monthly menstrual cycle stops)
  
• Changes in nails

There are some more severe side effects associated with Adriamycin, including:

• Allergic reaction
• Irreversible amenorrhea or early menopause in women
  
• Lower sperm counts, sperm problems, and loss of fertility in men
• Low white blood counts and greater risk of infection
• Chemotherapy-induced anemia (low red blood cell count)
• Thrombocytopenia (low platelet count)
• Heart muscle damage
• Skin damage (Adriamycin can damage the skin if it leaks out of the vein; talk to your oncologist about any redness, rashes, or tenderness near the infusion site.)

Pregnancy and Breastfeeding

Adriamycin can harm an unborn baby. Women who are able to become pregnant and men who take Adriamycin should use birth control (contraception) during treatment and for six months after treatment. If you or your partner becomes pregnant, tell your healthcare provider right away. 

For those who are breastfeeding or plan to breastfeed, Adriamycin can pass into your breast milk and harm your baby. You and your healthcare provider should decide if you will receive Adriamycin or breastfeed—you should not do both. 

Contraindications

The following drugs shouldn't be used along with Adriamycin because of potentially serious interactions:

• Gilotrif (afatinib)
• Erleada (apalutamide)
• Pradaxa (dabigatran)
• Visimpro (dacomitinib)
• Ferriprox (deferiprone)
• Savasysa (edoxaban)
• Balversa (erdafitinib)
• Zydelig (idelalisib)
• Sporanox (itraconazole)
• Serzone (nefazodone)
• Ofev (nintedanib)
• Kepivance (palifermin)
• Pomalyst (pomalidomide)
• Epclusa (sofosbuvir/velpatasvir)
• Xeljanz (tofacitinib)
• Herceptin (trastuzumab)

The list of drugs that require close monitoring when combined with Adriamycin is extensive. It is important to discuss everything you're taking—including over-the-counter drugs and nutritional supplements—with your healthcare provider. It never hurts to double-check with your pharmacist either.

People with the following conditions shouldn't be given this drug, or should be closely monitored while on it:

• Severe liver disease
• Severe myocardial insufficiency
• Recent myocardial infarction (blood flow to the heart is blocked in the previous four to six weeks)
• Severe, persistent, drug-induced myelosuppression (decreased bone marrow activity)
• Pregnancy

Before Treatment

Because this drug can cause heart problems, you should have a MUGA (multigated acquisition) scan, echocardiogram, or heart health evaluation done before starting treatment. This baseline exam will be used to compare your heart function during and after treatment. Other tests for kidney and liver function may also be needed.

During Treatment

Your healthcare provider will discuss what you must do before and during Adriamycin treatment to ensure the infusion is as safe as possible.

It's important to:

• Use reliable birth control and avoid pregnancy. Adriamycin can cause birth defects.
• Drink lots of fluids, especially water, to flush your kidneys and bladder.
• Avoid drinking alcohol and caffeine as these have a dehydrating effect that can dry out your tissues.

When to Call Your Healthcare Provider

If you have any of these symptoms while taking Adriamycin, call your healthcare provider:

• Fever of 100.5 F or higher
• Pain or redness at your injection site
• Bloody urine
• Unusual bruises or persistent bleeding
• Persistent cough, sore throat, shortness of breath
• Allergic symptoms, chest tightness, swelling of feet or ankles, rash, swollen throat or tongue

Summary

Adriamycin is a type of chemotherapy, which is used in combination with other chemotherapy medications to treat breast cancer. It can also be used to treat other cancers, such as ovarian cancer, sarcoma, and neuroblastoma.

Side effects of Adriamycin include nausea, vomiting, hair loss, mouth sores, and fatigue. It also may cause the heart muscle to weaken, so the amount of medication someone can get is limited.