Doxorubicin
The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.
Approved 1974. Backbone of AIM/doxorubicin-ifosfamide (sarcoma), CHOP/R-CHOP (lymphoma), ABVD/AVD (Hodgkin), AC/EC (breast), and MAP (osteosarcoma). Cumulative cardiotoxicity above ~400-450 mg/m2 limits use; dexrazoxane and liposomal formulations mitigate. Also the payload of early ADC attempts.
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- Route
- IV
- Schedule
- 75 mg/m2 every 3 weeks (sarcoma, single agent or with ifosfamide); 50 mg/m2 in CHOP; 25 mg/m2 days 1, 15 in ABVD
- Dose modifications
- Lifetime cumulative limit ~450 mg/m2 (lower with chest RT); hepatic dose reduction
- Monitoring
- Baseline and serial echocardiography or MUGA; counts; extravasation precautions
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Generic.
- Commercial insurance
- covered on label
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
- Notes
- Long-established generic: never subject to a technology appraisal; funded routinely through hospital formularies and NHS England systemic anti-cancer therapy protocols.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE search: doxorubicin. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 1974 | Broad: sarcomas, lymphomas, leukaemias, breast, and other solid tumours |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia single-agent 75 mg/m2 (ANNOUNCE control arm) | — | 60% |
| Cardiomyopathy (cumulative) at 400 mg/m2; rises steeply above 550 mg/m2 | 5% | — |
| Alopecia | 90% | — |
| Nausea/vomiting | 60% | — |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
| Country | Reimbursement | List price | Assistance |
|---|---|---|---|
| United Statesgeneric | — | Generic; low cost | — |
List prices are manufacturer or Medicare figures where publicly disclosed; net prices after rebates are usually lower. Reimbursement changes; check the payer.
Trials
topRecruiting now (live from ClinicalTrials.gov)
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S1826 moved checkpoint blockade into first-line Hodgkin lymphoma and made N-AVD a preferred regimen for advanced disease in patients from adolescence to older age, while removing radiotherapy for most. It also showed the value of a single trial spanning paediatric and adult groups. Longer follow-up is needed for overall survival and late immune effects in young patients.
POLARIX gave the first new first-line standard for DLBCL since rituximab was added to CHOP, and pola-R-CHP is now approved and widely used, especially in higher-risk or ABC-type disease. The gain is modest and survival is unchanged, so many clinicians still use R-CHOP in lower-risk or GCB-type patients. Cost and subgroup uncertainty drive ongoing debate.
ECHELON-1 made a targeted antibody-drug conjugate part of first-line Hodgkin therapy and eventually showed that this saves lives, not just relapses. It set the reference arm against which nivolumab-AVD (SWOG S1826) and BrECADD (HD21) were later compared. Neuropathy is the main price and needs proactive dose modification.
Latest papers
topQuery for this drug: (TITLE:"Doxorubicin" OR ABSTRACT:"Doxorubicin" OR TITLE:"Adriamycin" OR ABSTRACT:"Adriamycin") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Doxorubicin, not a curated reading list.