Doxorubicin liposomal

Trade name: Caelyxâ„¢ 10 ml (20 mg) and 25 ml (50 mg) vials Drug class: anthracycline Manufacturer: Essex

Indications: AIDS-associated Kaposi's sarcoma with < 200 CD4 cells/^l and severe mucocutaneous or visceral KS in patients not tolerating chemotherapy with other drugs or with progressive disease despite treatment.

Dose: in adults 20 mg/m2 in 250 ml 5 % glucose solution intravenously over 30 minutes. Repeat after 3 weeks.

Side effects: myelosuppression (only 10-15 %% neutropenia grade III-IV), cardiomyopathy, stomatitis (rarely severe), palmar-plantar erythrodysesthesia (PPE or hand-foot syndrome - erythematous rash which may be very painful. Treatment: cool affected areas). Rare: nausea (mild), diarrhea, alopecia.

Comments/Warnings: liposomal doxorubicin is contraindicated in decompensated cardiomyopathy, severe myelosuppression (neutrophils < 1,000/p.l, platelets < 50,000/^l) and in patients who have previously received maximum cumulative doses of anthracyclines.

Cardiological examination is important (ECG, echocardiography: left ventricular ejection fraction, LVEF) before initiation of treatment and at periodic intervals during treatment. If the cumulative dose of 450 mg/m2 is exceeded, echocardiography is necessary before each further cycle.

It is important to inform patients of PPE (may be induced by sweating, pressure, friction - therefore no tight gloves, no sun, no long warm showers, cool drinks). Do not administer intramuscularly or subcutaneously. This drug is expensive: in Germany, two 20 mg vials cost approximately 1,343 Euro!

References:

1. Lucia MB, Rutella S, Leone G, Larocca LM, Vella S, Cauda R. In vitro and in vivo modulation of MDR1/P-glycoprotein in HIV-infected patients administered HAART and liposomal doxorubicin. J Ac-quir Immune Defic Syndr 2002, 30: 369-78. http://amedeo.com/lit.php?id=12138343

2. Martin-Carbonero L, Barrios A, Saballs P, et al. Pegylated liposomal doxorubicin plus highly active antiretroviral therapy versus highly active antiretroviral therapy alone in HIV patients with Kaposi's sarcoma. AIDS 2004; 18: 1737-40. http://amedeo.com/lit.php?id=15280789

3. Newell M, Milliken S, Goldstein D, et al. A phase II study of liposomal doxorubicin in the treatment of HIV-related Kaposi's sarcoma. Aust N Z J Med 1998, 28: 777-83. http://amedeo.com/lit.php?id=9972406

4. Nunez M, Saballs P, Valencia ME, et al. Response to liposomal doxorubicin and clinical outcome of HIV-1-infected patients with Kaposi's sarcoma receiving HAART. HIV Clin Trials 2001; 2: 429-37. http://amedeo.com/lit.php?id=11673818

5. Nunez M, Machuca A, Soriano V, Podzamczer D, Gonzalez-Lahoz J. Clearance of human herpesvi-rus type 8 viraemia in HIV-1-positive patients with Kaposi's sarcoma treated with liposomal doxorubicin. AIDS 2000, 14: 913-9. http://amedeo.com/lit.php?id=10853972

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