Liposomal daunorubicin (DaunoXome®)
Liposomal daunorubicin is a chemotherapy drug given to treat Aids-related Kaposi’s sarcoma. It may occasionally be used to treat other blood-related cancers. This information should ideally be read with our general information on chemotherapy and your type of cancer.
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
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Daunorubicin is a chemotherapy drug. In liposomal daunorubicin, the molecules of the drug are enclosed (encapsulated) in a fatty coating known as a liposome. The liposome allows the daunorubicin to remain in the body for longer so that more of the chemotherapy is delivered to the cancer cells while having fewer side effects on healthy tissue.
Liposomal daunorubicin is a red fluid.
Liposomal daunorubicin is usually given by a drip (infusion) in one of the following ways:
through a fine tube (cannula) inserted into a vein, usually in the back of your hand
through a fine, plastic tube inserted under the skin and into a vein near your collarbone (central line)
through a fine tube inserted into a vein in the crook of your arm (PICC line).
The infusion usually takes about 30-60 minutes. It's usually given every two weeks for the treatment of Aids-related Kaposi's sarcoma. The dose may be adjusted depending on your response to the treatment.
Chemotherapy is given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.
Before you have your treatment your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others experience more. The side effects described here won't affect everyone who has liposomal daunorubicin chemotherapy and may be different if you are having more than one type of chemotherapy drug.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Liposomal dunorubicin can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38 °C (100.4 °F)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
iposomal daunorubicin can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Liposomal daunorubicin can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have ablood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Your mouth may become sore or dry, 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 reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Some people find that lioposomal daunorubicin causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Liposomal daunorubicin may cause you to feel breathless. Let your doctor know if you're breathless or notice any changes in your breathing.
Your urine may become a pink-red colour. This may last up to 48 hours after you’ve had your treatment. It's normal and is due to the colour of the liposomal daunorubicin.
Sensitivity of the skin to sunlight
During treatment with liposomal daunorubicin, and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Less common side effects
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Signs of an allergic reaction can include hot flushes, backache, headaches and swelling of the face and a feeling of tightness in the chest. Let your nurse know straight away if you experience any of these.
The nurse will stop the drip and the symptoms will gradually go. The drip will then be restarted and there are usually no further allergic reactions. Your doctor may prescribe a drug that can reduce these side effects and that can be given before your next treatments.
Changes in the way your heart works
High doses of this drug may cause changes in the muscle of the heart, which can affect how the heart works. The effect on the heart depends on the dose given. It's very unusual for the heart to be affected if you're receiving standard doses. If affected, the heart normally goes back to normal once the chemotherapy is finished. Tests to see how well your heart is working may sometimes be carried out before the drug is given.
Your hair may thin or fall out completely. This usually starts 3-4 weeks after starting treatment, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and body hair in other areas. Hair loss is temporary and your hair will grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Liposomal daunorubicin can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Leakage into the tissue around the vein (extravasation)
If this happens when liposomal daunorubicin is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Effects during treatment
Some people may have a red flush or itching along the vein while the drug is being given.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having liposomal daunorubicin as it may harm the developing baby. It’s important to use effective contraception while having this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our liposomal daunorubicin fact sheet, which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference . 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk(accessed September 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.