Liposomal doxorubicin

Liposomal doxorubicin is a type of chemotherapy. It is also known as Caelyx.

It is a treatment for a number of different cancer types.

How does liposomal doxorubicin work?

Doxorubicin is a type of chemotherapy drug called an anthracycline. It works by blocking an enzyme called topoisomerase 2 that cancer cells need in order to divide and grow. 

Liposomal doxorubicin is doxorubicin contained in tiny spheres called pegylated liposomes. These spheres keep the doxorubicin in the bloodstream longer, so that more of the drug reaches the cancer cells. 

How do you have liposomal doxorubicin?

You have liposomal doxorubicin as a drip (infusion) into your bloodstream.

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

How often do you have liposomal doxorubicin?

You have liposomal doxorubicin as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover. Depending on your cancer type, you might have treatment in the following way:

28 day cycle 

Each cycle of treatment lasts 28 days (4 weeks). You might have up to 6 cycles, taking around 6 months in total. You have each cycle of treatment in the following way:

14 day cycle

Each cycle of treatment lasts 14 days (2 weeks). You might have up to 6 cycles, taking around 3 months in total. You have each cycle of treatment in the following way:

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You will also have regular ECGs to see how well your heart works.

What are the side effects of liposomal doxorubicin?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Inflammation of the lining of the mouth, throat, food pipe (oesophagus) and stomach

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Less commonly, you might have a sore throat or inflammation of the food pipe (oesophagus) and lining of the stomach.

Soreness, redness and peeling of your hands and feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Pain in different parts of the body

You might have bone and muscle pain during treatment.

Less commonly, you might have pain in your joints, nerves, tummy (abdominal), chest, breast, mouth or when you pass urine.

Let your doctor or nurse know if you have pain. They can tell you how to manage it.

Skin changes

You might have a skin rash that is red and raised.

Less commonly, you might have dry, peeling skin that can be itchy. Or you might have blisters or darkening of your skin.

Your skin might change colour in areas where you had radiotherapy previously, but this is rare.

Don't go swimming if you have a rash or other skin problems because the chlorine in the water can make it worse. Speak to your doctor or nurse so they can look and see if there are any medicines such as creams or lotions that can help.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening, alert your nurse or doctor if you notice any of these symptoms
• changes in the way your body uses proteins, carbohydrates, and fat. You may also burn up calories faster than usual and lose muscle and body fat, causing you to lose weight (cachexia)
• not having enough fluid in your body (dehydration)
• feeling short of breath during exercise
• bruising, bleeding gums and nosebleeds due to a drop in the number of platelets in your blood
• feeling confused
• feeling anxious or very low in mood (depression)
• a fast heartbeat
• a high blood pressure that might cause headaches, confusion, vision problems or chest pain
• a low blood pressure that can cause you to feel lightheaded or dizzy. Rarely your blood pressure might drop when getting up from sitting or lying
• flushed skin
• coughing
• difficulty swallowing
• a dry mouth
• sweating more than usual
• a change to the amount of substances in the blood such as potassium, calcium and sodium. Rarely it can also affect your magnesium levels
• chest pain, rarely your chest might also feel uncomfortable or tight
• muscle spasms
• feeling generally unwell
• swollen hands, lower legs or feet. Rarely you might have swelling of your face
• sore, red and itchy eyes (conjunctivitis)
• numbness or tingling in the fingers and toes
• indigestion
• sleepiness or not being able to sleep (insomnia)
• dizziness
• taste changes
• headaches

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• heart changes such as changes in your heart rhythm, your heart muscle not pumping blood as well as it should (heart failure) or becoming thickened or stiff (cardiomyopathy).
• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
• producing too many platelets
• seizures (fits)
• feeling faint or passing out
• an unpleasant feeling when touched – symptoms can include itching, burning, tingling, stinging or pain
• eye changes such as blurred vision and increased tearing, or inflammation of the retina that can cause long term vision loss
• inflammation of a vein causing pain and tenderness along the vein
• a skin and tissue reaction at the drip site that can cause damage to the area – tell your nurse or doctor straight away if this happens
• tiny red spots or bruises on your arms or legs (petechiae)
• breaking wind (flatulence)
• gum changes causing redness, irritation and swelling of your gums
• nail changes such as colour changes and nails becoming brittle
• liver or kidney changes – you will have regular tests to check this

Other side effects

Liposomal doxorubicin can cause some people to develop a second cancer such as a blood cancer or mouth cancer. But there isn't enough information to work out how often these side effects might happen. Talk to your doctor or nurse more about this if you are worried.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else I need to know

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.