Doxorubicin Hydrochloride Liposome (Pegylated) Injection

• Type: Chemotherapy medication

• Drug Class: Anthracycline antineoplastic agent (liposomal formulation)

• Form: Sterile liposomal suspension for intravenous (IV) infusion

• Special Feature: The drug is enclosed in pegylated liposomes (tiny fat-based vesicles coated with polyethylene glycol), which circulate longer in the blood and deliver the drug more selectively to tumors.

How It Works

• Doxorubicin itself works the same way as conventional doxorubicin — by intercalating into DNA, inhibiting topoisomerase II, and generating free radicals, leading to cancer cell death.

• The pegylated liposome coating:

  • Prolongs circulation time (stays longer in the bloodstream)

  • Reduces exposure of the drug to healthy tissues, especially the heart

  • Allows more drug to accumulate in tumors due to their leaky blood vessels (enhanced permeability and retention effect)

Common Uses

Pegylated liposomal doxorubicin is often used when conventional doxorubicin is not suitable due to its heart toxicity risk:

• Ovarian cancer (recurrent or resistant)

• Multiple myeloma (in combination with bortezomib)

• Kaposi’s sarcoma (AIDS-related)

• Off-label: sometimes used in patients at high risk of cardiotoxicity who still need anthracycline therapy

Advantages

• Lower risk of heart damage compared to conventional doxorubicin

• Longer circulation time, leading to improved tumor targeting

• Suitable for patients who have already received near-maximal doses of regular doxorubicin

• Can be given at lower frequency (every 4 weeks in some protocols)

Possible Side Effects

Common:

• Hand-foot syndrome (palmar-plantar erythrodysesthesia) – redness, pain, peeling on palms/soles

• Mouth sores (mucositis)

• Nausea, vomiting

• Fatigue

• Low blood counts (neutropenia, anemia)

Less Common but Serious:

• Infusion-related reactions (fever, flushing, chest tightness)

• Skin rash or darkening

• Rare but possible heart toxicity (still much lower than conventional doxorubicin)

Precautions

• Should be administered slowly via IV infusion to minimize infusion reactions

• Monitor for hand-foot syndrome and adjust dose if severe

• Regular blood counts and liver function tests are necessary

• Still monitor heart function periodically, though risk is reduced

• Avoid extravasation (though liposomal form is less vesicant than regular doxorubicin)