# Doxorubicin

Source: https://onco.cc/drugs/doxorubicin/  
OnCo record `doxorubicin` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

Doxorubicin is an anthracycline from a soil bacterium that poisons topoisomerase II, intercalates into DNA and generates free radicals; its cardiotoxicity arises through topoisomerase II beta in cardiomyocytes. Approved in 1974, it is the backbone of AIM and doxorubicin-ifosfamide (sarcoma), CHOP and R-CHOP (lymphoma), ABVD and AVD (Hodgkin lymphoma), AC and EC (breast) and MAP (osteosarcoma). Cumulative cardiotoxicity above about 400 to 450 mg/m2 limits use, with cardiomyopathy in around 5% at 400 mg/m2 and rising steeply above 550 mg/m2, so serial echocardiography is required; dexrazoxane and liposomal formulations mitigate the risk. Neutropenia, alopecia and nausea are expected with every cycle. It was also the payload of early ADC attempts. This is the red chemotherapy that still anchors many curative regimens, rationed by what the heart can take over a lifetime.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-07
- Brand: Adriamycin
- Modality: Cytotoxic chemotherapy (anthracycline)
- Mechanism: Topoisomerase II poisoning and DNA intercalation with free-radical generation; cardiotoxicity via topoisomerase IIβ in cardiomyocytes.
- Approvals: US 1974: Broad: sarcomas, lymphomas, leukaemias, breast, and other solid tumours
- Dosing: IV; 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
- Toxicity (grade 3+): Neutropenia 60%

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Doxorubicin
- FDA label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Doxorubicin

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(MK-2870-005)](https://onco.cc/trials/nct06132958/), [Safety and Efficacy of Pembrolizumab (MK-3475) in Children and Young Adults With Classical Hodgkin Lymphoma (MK-3475-667/KEYNOTE-667)](https://onco.cc/trials/nct03407144/), [Safety and Efficacy Study of Epcoritamab in Subjects With Relapsed/Refractory Chronic Lymphocytic Leukemia and Richter's Syndrome](https://onco.cc/trials/nct04623541/), [Safety and Efficacy Trial of Epcoritamab Combinations in Subjects With B-cell Non-Hodgkin Lymphoma (B-NHL)](https://onco.cc/trials/nct04663347/), [SIOPEL-3](https://onco.cc/trials/siopel-3/), [SIOPEL-4](https://onco.cc/trials/siopel-4/), [Study of Axicabtagene Ciloleucel Versus Standard of Care Therapy in Participants With Relapsed/Refractory Follicular Lymphoma](https://onco.cc/trials/nct05371093/), [Study of Fruquintinib Plus Sintilimab for Treatment of Advanced Endometrial Cancer](https://onco.cc/trials/nct06584032/), [Study of Lurbinectedin in Combination With Doxorubicin Versus Doxorubicin Alone as First-line Treatment in Participants With Metastatic Leiomyosarcoma (SaLuDo)](https://onco.cc/trials/nct06088290/), [Study of Patritumab Deruxtecan Plus Pembrolizumab With Other Anticancer Agents in Participants With High-Risk Early-Stage Triple-Negative or Hormone Receptor-Low Positive/HER-2 Negative Breast Cancer (MK-1022-010, HERTHENA-Breast-03)](https://onco.cc/trials/nct06797635/), [Study of Pembrolizumab (MK-3475) Plus Chemotherapy Versus Placebo Plus Chemotherapy for HR+/HER2- Locally Recurrent Inoperable or Metastatic Breast Cancer (MK-3475-B49/KEYNOTE-B49)](https://onco.cc/trials/nct04895358/), [Study of Pembrolizumab (MK-3475) Versus Placebo in Combination With Neoadjuvant Chemotherapy & Adjuvant Endocrine Therapy in the Treatment of Early-Stage Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative (ER+/HER2-) Breast Cancer (MK-3475-756/KEYNOTE-756)](https://onco.cc/trials/nct03725059/), [Study of Sacituzumab Govitecan Versus Treatment of Physician's Choice in Participants With Endometrial Cancer After Platinum-Based Chemotherapy and Im](https://onco.cc/trials/nct06486441/), [Study of Subcutaneous Epcoritamab in Combination With Intravenous Rituximab and Oral Lenalidomide (R2) to Assess Adverse Events and Change in Disease ](https://onco.cc/trials/nct06191744/), [SWOG S1826](https://onco.cc/trials/swog-s1826/), [TA(E)C-GP Versus A(E)C-T for the High Risk TNBC Patients and Validation of the mRNA-lncRNA Signature](https://onco.cc/trials/nct02641847/), [Tamoxifen and Pegylated Liposomal Doxorubicin for the Treatment of Patients With Metastatic or Inoperable, Locally Advanced Triple Negative Breast Cancer](https://onco.cc/trials/nct06434064/), [Tazemetostat with doxorubicin as front-line therapy for advanced epithelioid sarcoma (EZH-301 run-in)](https://onco.cc/trials/tazemetostat-doxorubicin-es/), [to Evaluate Efficacy and Safety of HLX10 in Combination With Chemotherapy Versus Placebo in Combination With Chemotherapy as Neoadjuvant Therapy and HLX10 Versu](https://onco.cc/trials/nct04301739/), [Treatment Protocol of the NHL-BFM and the NOPHO Study Groups for Mature Aggressive B-cell Lymphoma and Leukemia in Children and Adolescents](https://onco.cc/trials/nct03206671/), [Trial of the Safety and Efficacy of Epcoritamab in Japanese Subjects With Relapsed or Refractory (R/R) B-Cell Non-Hodgkin Lymphoma (R/R B-NHL)](https://onco.cc/trials/nct04542824/), [TRIANGLE](https://onco.cc/trials/triangle/), [Tucidinostat in Combination With CHOP in Newly Diagnosed Peripheral T-Cell Lymphoma With Follicular Helper of T Cell Phenotype](https://onco.cc/trials/nct06947967/), [Using Tumor Models to Determine Treatments](https://onco.cc/trials/nct06813079/)
- pairings: [Caution: cumulative anthracycline dose and the heart](https://onco.cc/pairings/doxorubicin-cardio-caution/), [PD-1 blockade + AVD chemotherapy](https://onco.cc/pairings/pd1-plus-avd-hodgkin/)
- key papers: [Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk](https://onco.cc/key-papers/paper-van-nimwegen-cardiovascular-disease-after-hodgkin-jama-intern-med-2015/), [Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials](https://onco.cc/key-papers/paper-ebctcg-polychemotherapy-regimens-meta-analysis-lancet-2012/), [Dose-adjusted EPOCH-R compared with R-CHOP as frontline therapy for diffuse large B-cell lymphoma: clinical outcomes of the phase III intergroup trial Alliance/CALGB 50303](https://onco.cc/key-papers/paper-calgb-50303-da-epoch-r-vs-r-chop-jco-2019/), [Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial](https://onco.cc/key-papers/paper-eortc-h10-pet-adapted-early-hodgkin-jco-2017/), [Early relapse of follicular lymphoma after R-CHOP defines patients at high risk for death: an analysis from the National LymphoCare Study](https://onco.cc/key-papers/paper-casulo-pod24-follicular-lymphoma-jco-2015/), [ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma](https://onco.cc/key-papers/paper-echelon-1-brentuximab-avd-nejm-2018/), [EORTC 62012: doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced soft tissue sarcoma](https://onco.cc/key-papers/paper-eortc-62012-doxorubicin-ifosfamide-judson-lancet-oncol-2014/), [FIRM-ACT: combination chemotherapy in advanced adrenocortical carcinoma](https://onco.cc/key-papers/paper-firm-act-edp-mitotane-adrenocortical-carcinoma-nejm-2012/), [Four versus six cycles of CHOP chemotherapy in combination with six applications of rituximab in patients with aggressive B-cell lymphoma with favourable prognosis (FLYER)](https://onco.cc/key-papers/paper-flyer-four-vs-six-cycles-r-chop-lancet-2019/), [GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma](https://onco.cc/key-papers/paper-ghsg-hd10-reduced-intensity-early-hodgkin-nejm-2010/), [GHSG HD21: PET-guided BrECADD versus escalated BEACOPP in advanced-stage classical Hodgkin lymphoma](https://onco.cc/key-papers/paper-ghsg-hd21-brecadd-vs-ebeacopp-advanced-hodgkin-lancet-2024/), [Ibrutinib and rituximab versus immunochemotherapy in patients with previously untreated mantle cell lymphoma (ENRICH): a randomised, open-label, phase 2/3 superiority trial](https://onco.cc/key-papers/paper-enrich-ibrutinib-rituximab-mantle-cell-lancet-2025/), [IFM 2006 prospective trial: bortezomib-based induction and transplantation for primary plasma cell leukaemia](https://onco.cc/key-papers/paper-royer-plasma-cell-leukaemia-ifm-jco-2016/), [Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance)](https://onco.cc/key-papers/paper-sikov-calgb-40603-carboplatin-bevacizumab-jco-2015/), [LMS-04: doxorubicin plus trabectedin followed by trabectedin maintenance versus doxorubicin alone in metastatic leiomyosarcoma](https://onco.cc/key-papers/paper-lms-04-doxorubicin-trabectedin-lancet-oncol-2022/), [Long-term follow-up of nodular lymphocyte-predominant Hodgkin lymphoma treated in the GHSG HD7 to HD15 trials](https://onco.cc/key-papers/paper-eichenauer-nlphl-ghsg-hd7-hd15-long-term-jco-2020/), [Obinutuzumab or rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in previously untreated diffuse large B-cell lymphoma](https://onco.cc/key-papers/paper-goya-obinutuzumab-vs-rituximab-chop-dlbcl-jco-2017/), [PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study](https://onco.cc/key-papers/paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019/), [PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group](https://onco.cc/key-papers/paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017/), [POLARIX: swapping vincristine for the antibody-drug conjugate polatuzumab vedotin in first-line treatment of diffuse large B-cell lymphoma](https://onco.cc/key-papers/paper-polarix-polatuzumab-rchp-nejm-2022/), [Positron emission tomography-guided treatment in early-stage favorable Hodgkin lymphoma: final results of the international, randomized phase III HD16 trial by the German Hodgkin Study Group](https://onco.cc/key-papers/paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019/), [Randomized phase III trial of ibrutinib and R-CHOP in non-germinal centre B-cell diffuse large B-cell lymphoma (PHOENIX)](https://onco.cc/key-papers/paper-phoenix-ibrutinib-r-chop-non-gcb-dlbcl-jco-2019/), [RAPID: PET-directed therapy for early-stage Hodgkin lymphoma](https://onco.cc/key-papers/paper-rapid-pet-directed-therapy-early-hodgkin-nejm-2015/), [RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma](https://onco.cc/key-papers/paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016/), [SCALP: scalp cooling to prevent hair loss during chemotherapy for early breast cancer](https://onco.cc/key-papers/paper-scalp-trial-jama-2017/), [SIOPEL-3: cisplatin versus cisplatin plus doxorubicin for standard-risk hepatoblastoma](https://onco.cc/key-papers/paper-siopel-3-cisplatin-vs-plado-standard-risk-hepatoblastoma-perilongo-nejm-2009/), [SIOPEL-4: dose-dense cisplatin-based chemotherapy and surgery for high-risk hepatoblastoma](https://onco.cc/key-papers/paper-siopel-4-dose-dense-cisplatin-high-risk-hepatoblastoma-zsiros-lancet-oncol-2013/), [SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults](https://onco.cc/key-papers/paper-swog-s1826-nivolumab-avd-nejm-2024/), [VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801](https://onco.cc/key-papers/paper-jcog9801-vcap-amp-vecp-adult-t-cell-leukaemia-jco-2007/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- ideas: [A radiotherapy-free cure for early Hodgkin lymphoma that actually holds](https://onco.cc/ideas/lymphoma-ev-radiotherapy-free-early-hodgkin/), [Confirm or refute the harm of antioxidant supplements during chemotherapy](https://onco.cc/ideas/idea-nl-antioxidant-supplement-harm-confirmation/), [Give exceptional responders less: pembrolizumab omission after complete response, anthracycline-free regimens and chemotherapy omission in lymphocyte-rich stage I disease](https://onco.cc/ideas/idea-tnbc-de-escalation-for-exceptional-responders/), [Measure the late effects of the treatments being given now, not the ones given in 1975](https://onco.cc/ideas/lymphoma-ev-late-effects-of-the-treatments-given-now/), [Randomised evidence for the T-cell lymphomas, including the ones that are not in Europe or North America](https://onco.cc/ideas/lymphoma-ev-randomised-evidence-for-the-t-cell-lymphomas/), [The drugs that cure lymphoma, and the places that do not have them](https://onco.cc/ideas/lymphoma-ev-the-drugs-that-cure-and-the-places-without-them/)
- terms: [ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)](https://onco.cc/terms/abvd-beacopp/), [Alkylating agents and therapy-related myeloid neoplasms](https://onco.cc/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/), [Anthracyclines (doxorubicin, epirubicin)](https://onco.cc/terms/anthracycline/), [Cardiotoxicity (LVEF decline, cardiomyopathy)](https://onco.cc/terms/cardiotoxicity/), [HHV-8 (KSHV) status and LANA-1 immunohistochemistry](https://onco.cc/terms/hhv8-kshv/), [Histological response to induction chemotherapy (osteosarcoma and Ewing sarcoma)](https://onco.cc/terms/histological-response-induction/), [Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them](https://onco.cc/terms/lymphoma-tx-hodgkin-late-effects/), [PRETEXT and CHIC risk groups (hepatoblastoma)](https://onco.cc/terms/pretext-chic/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/), [SS18::SSX fusion (synovial sarcoma)](https://onco.cc/terms/ss18-ssx-fusion/), [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/), [Topoisomerase II inhibitors and the shorter latency](https://onco.cc/terms/rejuv-second-topoisomerase-inhibitors-short-latency/), [Wilms tumour risk markers (anaplasia, 1p/16q loss, 1q gain, SIOP and COG risk groups)](https://onco.cc/terms/wilms-risk-markers/)
- targets: [Topoisomerase II alpha (TOP2A)](https://onco.cc/targets/top2a/)
- people: [Alberto Gabizon](https://onco.cc/people/alberto-gabizon/), [Yechezkel Barenholz](https://onco.cc/people/yechezkel-barenholz/)
- drugs: [Aldoxorubicin](https://onco.cc/drugs/aldoxorubicin/), [Brigimadlin](https://onco.cc/drugs/brigimadlin/), [Daunorubicin](https://onco.cc/drugs/daunorubicin/), [Dexrazoxane](https://onco.cc/drugs/dexrazoxane/), [Epirubicin](https://onco.cc/drugs/epirubicin/), [Ethiodized oil](https://onco.cc/drugs/ethiodized-oil/), [Olaratumab](https://onco.cc/drugs/olaratumab/), [Pixantrone](https://onco.cc/drugs/pixantrone/), [Streptozocin](https://onco.cc/drugs/streptozocin/)
- pathways: [Drug efflux pumps (ABC transporters)](https://onco.cc/pathways/drug-efflux-pumps/)
- companies: [GI Innovation](https://onco.cc/companies/gi-innovation/)

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JSON: https://onco.cc/api/v1/entities/doxorubicin.json