How does it work?
Caelyx infusion contains the active ingredient doxorubicin hydrochloride, which is a type of anticancer medicine called a cytotoxic anthracycline antibiotic.
Cancers form when some cells within the body multiply uncontrollably and abnormally. These cells then spread and destroy nearby tissues. Doxorubicin works by stopping the cancer cells from dividing and multiplying. This kills the cancer cells and stops the cancer growing.
Doxorubicin's exact mechanism of action is unknown but it seems to work in three ways. Firstly, it inserts itself into the strands of genetic material (DNA) inside the cancer cells and binds them together. This prevents the cells from making genetic material (DNA and RNA) and proteins. It also appears to interfere with an enzyme called topoisomerase II, which is involved in DNA replication. This stops the cancer cells growing and multiplying. Finally it can also form free radicals, which are molecules capable of damaging the cancer cells.
Unfortunately, anticancer medicines also affect normal, healthy cells, particularly those that multiply quickly such as blood, gut and hair cells. The most important side effect is usually on the bone marrow where blood cells are made. Doxorubicin can decrease the production of white blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor levels of blood cells.
The doxorubicin in this medicine is contained in tiny spheres called pegylated liposomes. These spheres allow the doxorubicin to remain in the bloodstream for longer so that a greater amount is delivered to the cancerous cells, rather than to healthy tissue. This may result in fewer side effects than standard doxorubicin.
What is it used for?
- Breast cancer that has spread to other areas of the body.
- Advanced ovarian cancer when platinum-based chemotherapy has been unsuccessful.
- AIDS-related Kaposi's sarcoma (a form of skin cancer) in people with low CD4 counts.
- Bone marrow cancer (multiple myeloma) in combination with bortezomib, in people who have received at least one prior therapy and who have already had or are unsuitable for a bone marrow transplant.
How is it given?
- Caelyx infusion is given through a drip into a vein (intravenous infusion), over a period of 30 to 90 minutes. This is given by a doctor or nurse.
- If you notice any stinging or burning around the vein or any leakage of fluid from the cannula while this medicine is being given, it is important to tell the doctor or nurse immediately.
- How often the treatment is given and the number of cycles you have will depend on the type of cancer you are being treated for, how well it responds and how well your body copes with the chemotherapy.
- Your heart and liver function should be monitored before and during treatment with this medicine.
- Chemotherapy medicines can decrease the number of blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
- This medicine can cause redness, swelling and sores on the palms of your hands and soles of your feet. This side effect is known as hand-foot syndrome and can be severe. To minimise it there are various measures you should take for 4 to 7 days after each infusion, including keeping hands and feet uncovered (avoid socks/gloves/tight-fitting shoes) and soaking them in cool water when possible, eg when watching television. Avoid exposing the skin to very hot water, eg saunas and jacuzzis, and avoid exercise that might cause damage to the skin, eg jogging. For more advice talk to your cancer specialist.
- This medicine may be harmful to an unborn baby. For this reason, women being treated with this medicine should use effective contraception to prevent pregnancy, and men being treated this medicine should use effective contraception to avoid fathering a child, both during treatment, and for at least six months after treatment is finished. Women should consult their doctor immediately if they become pregnant.
- Your ability to get pregnant or father a child may be affected by treatment with this medicine. It is important to discuss fertility with your doctor before starting treatment.
Use with caution in
- People who have had radiotherapy treatment in the area of the chest cavity.
- People who have had treatment with other medicines that may have side effects on the heart, eg other anthracycline chemotherapy medicines.
- Heart disease.
- Decreased heart function.
- Decreased liver function.
- Diabetes (the infusion contains sucrose and glucose).
Not to be used in
- The manufacturer of this medicine has limited experience with this medicine in treating children and adolescents under 18 years of age. It is not recommended for this age group.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine may be harmful to an unborn baby. It should not be used during pregnancy unless considered essential by your doctor.
- Women being treated with this medicine should use effective contraception to prevent pregnancy, and men being treated with this medicine should use effective contraception to prevent fathering a child, both during treatment, and for at least six months after treatment is finished. Consult your doctor immediately if you think you could be pregnant.
- It is not known whether this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Painful redness, swelling, blistering or ulceration of the palms of hands and soles of feet (palmar-plantar erythrodysesthesia - see warning section above).
- Sore mouth and mouth ulcers.
- Nausea and vomiting. You will be given medicines to help prevent this.
- Feeling weak or tired.
- Decrease in the number of healthy white blood cells, red blood cells or platelets in the blood (leukopenia and neutropenia, anaemia and thrombocytopenia) see warning section above.
- Fever (high temperature).
- Hair loss (alopecia).
- Loss of appetite.
- Disturbances of the gut such as diarrhoea, constipation or abdominal pain.
- Skin reactions such as rash, dry skin, changes in pigmentation and itching.
- Sore throat.
- Pins and needles sensations.
- Feeling sleepy.
- Weight loss.
- Shortness of breath.
- Heart problems such as irregular heart beats or heart failure.
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
You should tell your doctor what medicines you are taking, including those bought without a prescription and herbal medicines, before you start your chemotherapy. Likewise, always check with your doctor or pharmacist before taking any new medicines during your treatment.
There may be an increased risk of side effects if this medicine is used in combination with other anticancer medicines.
Sorafenib, verapamil and paclitaxel may increase the blood level of doxorubicin.
High doses of ciclosporin increase the blood level and risk of side effects of doxorubicin.
This medicine may decrease the effect of stavudine used to treat HIV infection.
Vaccines may be less effective in people receiving chemotherapy. This is because chemotherapy medicines reduce the activity of the immune system and can prevent the body forming adequate antibodies. Live vaccines should be postponed until at least six months after finishing chemotherapy because they may cause infection. Live vaccines include the following: oral polio; rubella; measles, mumps and rubella (MMR); BCG; yellow fever and oral typhoid vaccines.
Other medicines containing the same active ingredient
Doxorubicin injection is also available without a brand name, ie as the generic medicine.