Anthracyclines for Breast Cancer
If you’ve been diagnosed with early-stage, HER2-negative breast cancer or metastatic breast cancer, your doctor may prescribe anthracycline chemotherapy.
Anthracyclines are made from the Streptomyces peucetius bacterium. They work by stopping cancer cells from replicating or growing.
Anthracyclines used to treat breast cancer are:
daunorubicin (brand names: Cerubidine, DaunoXome)
Adriamycin (chemical name: doxorubicin)
Doxil (chemical name: doxorubicin HCl liposome)
Ellence (chemical name: epirubicin)
mitoxantrone (brand name: Novantrone)
How anthracycline chemotherapy is given
Anthracyclines are given by injection or intravenous (IV) infusion. Depending on which medication you’re prescribed, you’ll get anthracycline chemotherapy infusions every one to three weeks for four to six cycles, with each infusion lasting anywhere from fifteen minutes to two hours.
The dose of anthracycline chemotherapy prescribed to you will depend on the type and stage of the breast cancer, the other medications you’re taking as part of your treatment plan, and your weight.
Anthracyclines are sometimes given in combination with other chemotherapy, targeted therapy, or immunotherapy medications. Chemo regimens that include an anthracycline are:
Common risks and side effects of anthracyclines
Like almost all breast cancer medicines, anthracyclines can cause side effects. Some of them can be severe.
The most commonly reported side effects of anthracyclines are hair loss, gastrointestinal side effects (like nausea, vomiting, and appetite loss), and weakness and/or fatigue.
Other common side effects include:
irregular periods — this can include temporary cessation (usually resumes after medication is completed) or permanent cessation of menstrual periods, depending on your age and other factors
blue-green colored urine for 24 hours after receiving mitoxantrone or reddish-orange urine
feverand chills
low white blood cell count (leukopenia or neutropenia)
Some common side effects are more severe, such as heart problems, including congestive heart failure: Your doctor will recommend heart testing before starting treatment with anthracycline chemotherapy, and may repeat this heart testing at intervals of several months while you are receiving anthracyclines.
If you have a history of cardiovascular disease, you should be treated with anthracyclines only when the potential benefit of treatment outweighs the risk, and when heart testing shows that your heart is functioning normally.
Rare side effects of anthracyclines
Rare but potentially severe side effects include:
Tissue death (necrosis): Necrosis can occur if an anthracycline chemotherapy medication leaks into the skin and subcutaneous tissues during an infusion.
Allergic reaction: Symptoms of allergic reaction can range from mild to life-threatening. Signs of an allergic reaction include:
hives or a skin rash
trouble breathing or feeling like you might pass out
swelling of your face, lips, tongue, or throat
Doctors should not prescribe anthracyclines if you’re breastfeeding.
Managing the side effects of anthracycline chemotherapy
Dealing with things like gastrointestinal discomfort, hair loss, and fatigue during treatment can be frustrating and even debilitating, but there are ways to reduce chemo side effects. Your doctor may prescribe pre-meds, which are medications given before treatment, or supportive care medications, which are given during treatment.
For example, Neulasta (chemical name: pegfilgrastim), Neupogen (chemical name: filgrastim), or Zarxio (chemical name: filgrastim-sndz) can be taken during chemo to improve your white blood cell count.
Other tips include:
wearing a cold cap or scalp cooling system during chemotherapy infusions to reduce hair loss
picking up your prescription and over-the-counter anti-nausea medicines before chemo starts, and taking them even if you’re not sure you need them
giving short-term fasting (eating little or no food) a try — before, during, and after chemo — to reduce fatigue. Make sure you talk to your care team before trying it out.
drinking 64 to 96 ounces of hydrating beverages each day, especially before, during, and after chemo. This helps prevent dehydration, which contributes to weakness, headaches, and other side effects of anthracyclines.
It’s important to talk to your doctor about any anthracycline side effects you experience. If pre-meds or other remedies aren’t helping, it may be possible to lower your dose of chemotherapy.
Real patient reviews
Members of the Breastcancer.org community discuss their experiences with anthracycline chemotherapy in our discussion forums. Here are some of their comments.
“Adriamycin (doxorubicin) can be tough. Doxil (liposomal doxorubicin) is a different story. With the liposomal formula, all of the tough side effects of Adriamycin are avoided — no hair loss, no major nausea/vomiting, no extreme fatigue. The primary side effect of Doxil is rashes that typically present during the first few cycles and then disappear. I took Doxil for 9 months last year with no port. Very tolerable drug.” — JFL
“The only side effects I had [from mitomycin, methotrexate, and mitoxantrone] were partial hair loss, and pneumonia just before the last of 6 3-weekly shots due to low blood counts.” — suems
“I’m feeling much better since I started [Adriamycin (doxorubicin)]. My tumor marker has dropped from over 3800 to 614. My liver blood test results have returned to normal. I had a CT scan on Tuesday, and I expect to see good results.” — 50sgirl
