Liposomal doxorubicin (Caelyx®, Myocet®)
Liposomal doxorubicin is a chemotherapy drug usually given to treat advanced ovarian cancer, advanced breast cancer and Aids-related Kaposi's sarcoma. It may also be given to treat myeloma.
Doxorubicin is a chemotherapy drug. In liposomal doxorubicin, the molecules of the drug are enclosed (encapsulated) in a fatty coating known as a liposome. The liposome allows the doxorubicin to remain in the body for longer. This means more of the chemotherapy is delivered to the cancer cells while having fewer side effects on healthy tissue.
Liposomal doxorubicin isn't suitable for everyone who needs doxorubicin. You may find it helpful to discuss this with your cancer specialist who can advise you 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® and Myocet®.
Caelyx® is a form of doxorubicin that is enclosed in liposomes. It is sometimes known as pegylated doxorubicin hydrochloride (PLDH). It is used to treat:
advanced ovarian cancer that has come back after being treated with a platinum-based chemotherapy drug
women with advanced breast cancer who have an increased risk of heart damage from other chemotherapy drugs
Aids-related Kaposi's sarcoma.
myeloma that has progressed after previous treatment - it's given in combination with another chemotherapy drug, cyclophosphamide.
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 (cannula) inserted into a vein, usually in the back of your hand
through a fine, plastic tube that is inserted under the skin and into a vein near the collarbone (central line)
into a fine tube that is inserted into a vein in the crook of your arm (PICC line).
The infusion usually takes 60–90 minutes.
Chemotherapy is usually 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 begin 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 may experience more. The side effects described below won't affect everyone who has liposomal doxorubicin and may be different if you're 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 doxorubicin 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'll 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 38ºC (100.4ºF)
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
Liposomal doxorubicin 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 doxorubicin 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 a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
This may begin soon after the treatment is given and can last for up to 24 hours. 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 if it 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.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment 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.
Sometimes areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.
Soreness and redness of the palms of the hands and soles of the feet
This is sometimes known as palmar-plantar, or hand and foot syndrome. It can happen after two or three cycles of treatment with Caelyx. It's usually temporary and improves when the treatment is finished.
Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful. 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 if you're being treated with Myocet.
Hot flushes or backache
Some people may experience hot flushes or backache when the drug is being given. A mild painkiller, such as paracetamol, can help to relieve backache.
Your urine may become a pink/red colour. This may last for a few hours after having liposomal doxorubicin. It's normal and is due to the colour of the drug.
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 operate or drive machinery.
Less common side effects
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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 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 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 have 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.
This is more likely to occur if you're being treated with Myocet, although it can happen with both. It usually starts 2–4 weeks after the first dose, although it may occur earlier. Your hair may thin but could fall out completely, although this is rare. This is temporary and your hair will start to grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before treatment. Your nurse can give you advice about coping with hair loss.
Abdominal pain and constipation
Liposomal doxorubicin can cause pain in your tummy (abdomen) and constipation. Let your doctor know if you develop pain. It can usually be controlled with mild painkillers.
This can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Liposomal doxorubicin 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.
Treatment with liposomal doxorubicin may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
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 doxorubicin 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.
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.
Some medicines, including those 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're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
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 taking liposomal doxorubicin as it may harm the developing baby. It’s important to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor or nurse.
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.
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 doxorubicin factsheet 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. (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.