Daunorubicin

Daunorubicin is an anthracycline chemotherapy agent used to treat certain leukemias and other malignancies. It is a cytotoxic antibiotic derived from Streptomyces species and is typically given by intravenous infusion.

Mechanism of action

Daunorubicin intercalates into DNA and inhibits topoisomerase II, disrupting DNA replication and transcription. It also generates free radicals that contribute to DNA damage and cell death. These actions lead to dose-dependent cytotoxic effects on rapidly dividing cancer cells, though they can affect healthy tissues as well.

Medical uses

Daunorubicin is primarily used in the treatment of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) as part of combination regimens. In AML, it is commonly combined with cytarabine in a standard induction regimen often referred to as 7+3. The drug is also employed in some lymphomas and myelodysplastic syndromes, depending on institutional protocols and patient factors.

Administration and dosing

Daunorubicin is administered intravenously. It is not generally effective when taken orally due to poor bioavailability. Dosing and schedules vary by regimen, disease type, patient age, and prior treatments, with careful consideration given to cumulative exposure due to potential toxicities.

Side effects and safety

Common adverse effects include myelosuppression, nausea, vomiting, mucositis, and alopecia. A major long-term risk is cardiotoxicity, which is dose-related and can lead to congestive heart failure; cardiac function is monitored before and during therapy. Other risks include mucositis, liver enzyme elevations, and reddish discoloration of urine and sweat. The drug can cause extravasation if IV access is inadequate. Daunorubicin is teratogenic and generally avoided in pregnancy. Protective strategies and dose adjustments may be used in patients with hepatic impairment or prior anthracycline exposure.

Monitoring

Patients receiving daunorubicin typically have serial complete blood counts, liver function tests, and periodic cardiac evaluations (echocardiography or MUGA scans) to assess for cardiotoxicity and adjust dosing as needed.