doksorubisiini

Doksorubisiini, also known as doxorubicin, is an anthracycline chemotherapy agent used to treat a wide range of cancers. It is typically given by intravenous infusion and is one of the most widely used anticancer drugs in combination regimens.

Mechanism of action is multifaceted. Doksorubisiini intercalates into DNA, inhibits the enzyme topoisomerase II, and generates reactive oxygen species. These effects lead to DNA damage and cell death, contributing to tumor control. The drug also disrupts cellular membranes and mitochondrial function, which can enhance cytotoxicity.

Common indications include breast cancer, various leukemias and lymphomas, sarcomas, and certain solid tumors. Doksorubisiini is often part of combination therapies, with dosing tailored to cancer type, patient factors, and prior treatments. It is usually administered in cycles over several weeks.

Pharmacokinetics and metabolism involve wide tissue distribution and hepatic metabolism to active metabolites such as doxorubicinol. Excretion occurs mainly via the biliary system and, to a lesser extent, the urine. The pharmacokinetic profile can be altered by liver impairment or extensive prior therapy.

Adverse effects are dose-related and can be serious. Myelosuppression, mucositis, nausea, vomiting, and alopecia are common. Infusion reactions and extravasation injury may occur. A characteristic reddish discoloration of urine, sweat, and tears can be observed. Cardiotoxicity is a major limitation, with risk increasing with cumulative dose and certain pretreatment factors (e.g., prior chest radiation). Dexrazoxane can be used in some cases to reduce cardiotoxic risk.

Contraindications include significant baseline cardiac dysfunction. Cautions involve liver impairment, pregnancy, and interactions with other cardiotoxic or myelosuppressive drugs. Doksorubisiini has a long-standing role in cancer therapy but requires careful monitoring for cardiac and other toxicities.