Doxil (Doxorubicin Liposomal) for Multiple Myeloma

Doxil (doxorubicin liposomal) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for treating adults with multiple myeloma.

How Doxil Works and How It’s Taken

Doxil is a type of medication called an anthracycline topoisomerase inhibitor. It works by binding to DNA and blocking cells from making the genetic material they need to grow and divide.

In multiple myeloma, this helps reduce abnormal myeloma cell activity and slow the growth of cancer cells.

Oncologists prescribe Doxil for individuals with multiple myeloma who have had at least one prior treatment, have not previously received bortezomib, and will use it together with bortezomib.

Doxil is given as an intravenous infusion (into the vein), typically on day 4 of each 21-day cycle. It is given after bortezomib as part of combination treatment.

Typical Dosing for Multiple Myeloma

The recommended dose of Doxil for multiple myeloma is 30 milligrams per square meter, given by intravenous infusion over 60 minutes on day 4 of each 21-day cycle for eight cycles or until disease progression or unacceptable toxicity. The dose is based on body surface area, which is a standard calculation using height and weight to help doctors choose the right dose for each individual.

Oncologists may delay treatment, lower the dose by 25 percent, or stop treatment based on side effects such as hand-foot syndrome, mouth sores, low blood counts, or other serious side effects.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Doxil Side Effects

In a clinical study of Doxil used with bortezomib to treat multiple myeloma in adults who had not previously received bortezomib and had received at least one prior therapy, the most common side effects occurred in about 19 percent to 48 percent of people. These included:

Nausea
Diarrhea
Peripheral neuropathy (nerve damage that can cause numbness, tingling, or pain, usually in the hands or feet)
Fatigue (extreme tiredness that doesn’t improve with rest)
Neutropenia (low white blood cell counts)
Thrombocytopenia (low platelet counts)
Vomiting
Constipation
Pyrexia (fever)
Asthenia (weakness)
Rash
Hand-foot syndrome (painful discoloration, swelling, or peeling on the palms or soles)
Anemia (low red blood cell counts)
Anorexia (loss of appetite)
Stomatitis (mouth sores or inflammation in the mouth)

Serious Side Effects and Warnings

Doxil can cause serious side effects that may require immediate medical attention. These include:

Cardiomyopathy and heart failure — Heart muscle damage can lead to trouble breathing, swelling, or fatigue.
Infusion-related reactions — Serious allergic-type reactions during the infusion may include flushing, shortness of breath, chest or throat tightness, swelling, rash, dizziness, or fainting.
Myelosuppression — Severe low blood cell counts can raise the risk of serious infections, bleeding, or severe anemia.
Severe skin reactions — These can include Stevens-Johnson syndrome and toxic epidermal necrolysis, which can cause widespread rash, blistering, and skin peeling.
Secondary oral cancers — New cancers in the mouth have been reported with long-term use, sometimes during treatment or years later.
Embryo-fetal toxicity — Doxil can harm your baby if used during pregnancy.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Doxil

Before starting Doxil, your doctor will check your heart function, such as with an echocardiogram or a MUGA scan.

Tell your doctor if you have any allergies to doxorubicin liposomal or any ingredients in Doxil.

Tell your doctor about all medications you take, including prescription drugs, over-the-counter medicines, and supplements.

Doxil should not be used in individuals who have had a severe allergic reaction, including anaphylaxis, to doxorubicin hydrochloride.

After treatment, your urine or other body fluids, such as sweat or tears, may look reddish-orange. This can happen because of the color of the medicine and usually goes away as the drug leaves your body.

Doxil is also FDA-approved to treat other cancers such as ovarian cancer and AIDS-related Kaposi’s sarcoma.

Doxil may also affect fertility in females and males. This may be temporary or permanent. Talk with your doctor before treatment if you may want to have children in the future.

Doxil can harm your baby if you are pregnant. Your doctor should verify you are not pregnant before you start treatment. Use effective birth control during treatment and for six months after your last dose, for both females who can become pregnant and males with partners who can become pregnant. Do not breastfeed during treatment with Doxil.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Doxil?

In a study of people with multiple myeloma whose disease had progressed during or after at least one prior therapy, Doxil plus bortezomib delayed disease worsening longer than bortezomib alone. The median time to progression (worsening of disease) was 282 days, or 9.3 months, with the combination compared with 197 days, or 6.5 months, with bortezomib alone. The response rate was 48 percent with Doxil plus bortezomib and 43 percent with bortezomib alone.

At a median follow-up of 8.6 years, median survival was 33 months with the combination and 31 months with bortezomib alone.

What tests or monitoring are needed with Doxil for multiple myeloma?

Heart monitoring is needed before starting Doxil, during treatment, and after treatment because it can cause heart muscle damage, including acute left ventricular failure. Left ventricular function is assessed with tests such as an echocardiogram or MUGA scan. Blood counts are also monitored because Doxil can cause neutropenia, thrombocytopenia, and anemia.