Liposomal doxorubicin (pronounced li-po-so-mall docks-o-rou-bi-sin) is a chemotherapy drug that is given as a treatment for some types of cancer. It is most commonly used to treat ovarian cancer and Aids-related Kaposi's sarcoma, but may also be used to treat advanced breast cancer. This information describes liposomal doxorubicin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give further information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Doxorubicin is a chemotherapy drug. In liposomal doxorubicin the molecules of the drug are enclosed (encapsulated) in a fatty coating known as liposome. The liposome allows the doxorubicin to remain in the circulation for longer so that a greater amount of chemotherapy is delivered to the cancer cells, while having fewer side effects on healthy tissue.

Liposomal doxorubicin is not suitable for everyone who needs doxorubicin and you may find it helpful to discuss this with your cancer specialist, who will be able to advise you on whether this type of treatment is appropriate for you.

There are two liposomal doxorubicin drugs that work in slightly different ways and are used to treat different types of cancer. These are:

Caelyx®, which is a pegylated form of doxorubicin that is enclosed in liposomes. It is sometimes known as pegylated doxorubicin hydrochloride (PLDH). Caelyx is used to treat:

• Aids-related Kaposi's sarcoma
• advanced ovarian cancer that has come back after treatment with a platinum based chemotherapy drug
• women with advanced breast cancer who have an increased risk of heart damage from other chemotherapy drugs.

Myocet®, another form of liposomal doxorubicin, is used to treat advanced (metastatic) breast cancer in combination with another chemotherapy drug, cyclophosphamide.

Liposomal doxorubicin is a light red fluid.

Liposomal doxorubicin may be given by a drip (infusion):

• through a fine tube inserted into the vein (cannula)
• through a central line which is inserted under the skin into a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of your arm.
  The infusion usually takes 60–90 minutes.

Each person's reaction to chemotherapy is different. Some people have very few side effects; while others may experience more. The side effects described in this information will not affect everyone who is given liposomal doxorubicin.

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Liposomal doxorubicin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, while your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• Your temperature goes above 38ºC (100.5ºF)
• You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Liposomal doxorubicin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with liposomal doxorubicin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicine to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Skin changes Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Areas of skin that have previously been treated with radiotherapy may become sensitive again while you are being treated with liposomal doxorubicin.

Soreness and redness of the palms of the hands and soles of the feet If you are being treated with Caelyx, you may develop red palms and soles of the feet, sometimes referred to as palmar plantar, or hand and foot syndrome. This effect can begin after two or three cycles of treatment, but is temporary. It will usually begin to improve within one to two weeks after the treatment is finished. You may be prescribed vitamin B6 (pyridoxine), which can help to reduce this. It can also help to keep your hands and feet cool and to avoid tight fitting clothing, such as socks, shoes and gloves. Palmar plantar is unlikely to happen if you are being treated with Myocet.

Hot flushes or backache Some people have hot flushes or backache when the drug is being given.

Sensitivity to the sun While you are having liposomal doxorubicin, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but always wear a high protection factor suncream and protective clothing.

Discoloured urine Your urine may become a red/orange colour. This may last for a few hours after having liposomal doxorubicin and is due to the colour of the drug. It is quite normal.

Fever, chills and allergic reactions Back pain, breathlessness, headaches and swelling of the face may occur from the time the drug is given. If you do develop these symptoms the infusion may be stopped and re-started at a slower rate. Your doctor may prescribe a drug that can reduce these side effects and which can be given before your next treatments.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Nausea (feeling sick) and vomiting If you do feel sick it may begin a few hours after the treatment is given and can last for up to a day. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Changes in the way your heart works Liposomal doxorubicin can affect how the heart works. The effect on the heart depends on the dose given. It is very unusual for the heart to be affected by standard doses of this treatment.

Hair loss This is more likely to occur if you are being treated with Myocet than Caelyx, although it can happen with both. It usually starts 2–4 weeks after the first dose of liposomal doxorubicin, although it may occur earlier. Your hair may just thin but could be lost completely, although this is rare. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to regrow once the treatment ends.

If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site it is very important that you tell the doctor or nurse. If the area around the injection site becomes red or swollen at any time while you are at home you should ring the clinic or ward and ask to speak to the doctor or nurse.

Other medicines Some medicines may be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking liposomal doxorubicin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

This section is based on our liposomal doxorubicin factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (33rd ed). Eds. Sweetman et al. Pharmaceutical Press, 2006.
• British National Formulary (52nd edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2006.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott Williams and Wilkins, 2001.
• Full guidance on the use of pegylated liposomal doxorubicin hydrochloride (PLDH) for the treatment of advanced ovarian cancer. National Institute for Clinical Excellence, July 2002.

For further references, please see general bibliography.