Doxorubicin is one of the oldest chemotherapy drugs that has been used to treat mesothelioma. It has been tested in combination with other drugs and for intraoperative use in more recent trials.

Treating Mesothelioma With Doxorubicin

Doxorubicin is one of the most heavily researched mesothelioma chemotherapy drugs and also one of the oldest. Although still used for treating mesothelioma patients, its use is far less common since the development of better-performing drugs. Doxorubicin also goes under the brand names of Adriamycin and Doxil.

  • Survival Benefit

    Survival rates for patients where doxorubicin was used alone have been generally low. It is usually used for inoperable late stage patients. Doxorubicin has also proven to provide some survival benefit when combined with other drugs.

  • Side Effects

    This chemotherapy drug carries some potentially serious side effects, so specialists typically only use doxorubicin if a patient isn’t responding to standard chemotherapy. Common side effects are hair loss, nausea and vomiting.

  • Clinical Trials

    Doxorubicin has been continuously tested in clinical trials. Mesothelioma patients should exercise caution in signing up for trials that include doxorubicin because it may exclude them from trials in which being treated with standard chemotherapy is required for eligibility.

What Is Doxorubicin?

Doxorubicin was approved over 30 years ago as a chemotherapeutic agent. It is most commonly used to treat blood cancers and leukemia, but also many types of solid tumors.

As one of the oldest approved chemotherapy drugs, it is unsurprising that this drug has been extensively researched for mesothelioma. It has been used in multiple applications and combinations with other drugs, including:

  • Cisplatin
  • Cisplatin and cyclophosphamide
  • Valproate acid (anticonvulsant and mood-stabilizer)
  • Tamoxifen (commonly used in breast cancers)

Doxorubicin is a red liquid chemotherapy drug that is administered both intravenously and intraoperatively. Inhalation of the drug has also been tested. It is used for both pleural and peritoneal mesothelioma patients. It’s an antineoplastic drug, meaning it interferes with cancer growth by preventing DNA replication and prevents metastasis.

A British Phase II clinical trial testing doxorubicin in combination with cisplatin in advanced mesothelioma patients resulted in a median survival time of 19.6 months.
  • Intraoperative Chemotherapy

    Doxorubicin is sometimes combined with the chemotherapy drug cisplatin for use during surgery. Doctors use this combination to “bathe” the area where tumors were removed to kill any microscopic cancer cells left over. It has been used for patients having an abdominal cytoreduction and those having an extrapleural pneumonectomy.

  • Inoperable Late Stage Patients

    This chemotherapy drug is sometimes used as the first line of treatment for patients with advanced mesothelioma. Some studies have demonstrated impressive results when doxorubicin is combined with another chemotherapy drug.

  • Chemotherapy-Resistant Patients

    One of the biggest issues with mesothelioma is that many patients don’t respond to chemotherapy. Doxorubicin may be given as an alternative in these cases. One clinical trial is testing the effect of doxorubicin and valproate acid in patients not responding to standard chemotherapy.

Aggressive Clinical Trial with Doxorubicin

A clinical trial taking place at Columbia University is researching the potential of a multimodal treatment that includes doxorubicin to treat pleural mesothelioma.

Participants in the study undergo intrapleural chemotherapy with doxorubicin and cisplatin via lung catheters for 6 non-consecutive weeks. Systemic chemotherapy with Alimta and cisplatin is given 3 three times at different intervals during chemotherapy, finally followed by intrapleural radiation therapy.

Patients in this study have to undergo thoracoscopy for the intrapleural procedures. The purpose of the study is to determine if radical surgery can be avoided and still offer the patient a similar survival benefit. The study may be of interest for patients who don’t want an aggressive surgery.

The extrapleural pneumonectomy and pleurectomy/decortication are still considered the best options for pleural mesothelioma patients to improve their life expectancy. Seeing a specialist is critical before a patient decides on a treatment or participation in clinical trials. Get a second opinion from a mesothelioma specialist using our free Doctor Match program.

Side Effects

One of the biggest downfalls of doxorubicin is the side effects associated with the drug, the most serious of which is potential heart failure. Therefore, many mesothelioma specialists tend to avoid using doxorubicin in favor of more mild chemotherapy drugs.

The most common side effects are:

  • Hair loss
  • Nausea
  • Vomiting
  • Mouth and lip sores
  • Red-colored urine (1-2 days after administration)

Patients are given anti-nausea medication before and after being given doxorubicin to help with the drug’s side effects.

It is important for a patient to notify their doctor of any strange symptoms. The drug can weaken the immune system and increase risk of bleeding. Symptoms such as fever or chills should also be brought up to a doctor.

The more serious side effects of doxorubicin are heart and kidney failure. For this reason, especially in older mesothelioma patients, specialists may be hesitant about prescribing this treatment.

Is Doxorubicin Right For You?

Like any form of treatment, there are benefits and consequences to using doxorubicin. Some reasons patients might be treated with doxorubicin include:

  • Resistance to standard chemotherapy
  • Late stage mesothelioma
  • Intraoperative chemotherapy

Only an experienced mesothelioma specialist can determine if doxorubicin, in any combination, is right for you.