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Treatment Name: Liposomal Doxorubicin (Doxil®) + Carboplatin

Liposomal Doxorubicin (Doxil®) + Carboplatin is a Chemotherapy Regimen for Ovarian Cancer

How does liposomal doxorubicin (Doxil®)+ carboplatin work?
Each of the medications in liposomal doxorubicin + carboplatin are designed to kill or slow the growth of ovarian cancer cells. 

Liposomal doxorubicin (Doxil) is a specific formulation of the chemotherapy drug doxorubicin, where doxorubicin is placed inside a sphere-shaped object called a liposome. When doxorucibin is inside the liposome, it makes it more difficult for the body to remove the drug so it stays in the blood longer and has more time to affect cancer cells.

Goals of therapy:
Liposomal doxorubicin + carboplatin is given to shrink tumors and decrease symptoms from ovarian cancer and is not commonly given with the goal of cure.

Schedule

  • Liposomal doxorubicin (Doxil®) intravenous (I.V.) infusion on Day 1. For the first Cycle the infusion rate varies for each patient- it is slowly ramped up. If no infusion reactions occur with the first dose, all treatments after Cycle 1 are given over one hour
  • Carboplatin I.V. infusion over 30 minutes on Day 1

Estimated total infusion time for this treatment:

  • Up to three hours for Day 1 of each cycle; Up to two hours for Cycles 2 and beyond if no reactions occur
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time 

Liposomal doxorubicin + carboplatin is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick to get their dose as an outpatient.

Liposomal doxorubicin + carboplatin is repeated every 28 days. This is known as one cycle. Each cycle may be repeated until the drug no longer works or unacceptable side effects are experienced. In some cases, treatment may need to be stopped due to the increased risk of experiencing heart toxicity such as decreased LVEF. This typically occurs approximately after 15 total cycles or sooner if prior radiation to the chest or treatment with other anthracycline drugs were given.

Duration of therapy depends upon response, tolerability, and number of cycles prescribed.

Click here for the common Liposomal doxorubicin (Doxil®) + carboplatin starting doses.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported liposomal doxorubicin + carboplatin side effects are shown here.

Roughly 6% of patients discontinue treatment due to unacceptable side effects.

Note: Hair loss from liposomal doxorubicin + carboplatin occurs in roughly 1 out of 3 people. Hair loss from liposomal doxorubicin + carboplatin is usually mild, not obvious from a distance, and seen only on close inspection. A different hair style can help cover some hair loss, and a wig or hair piece is usually not needed. Roughly 7% of patients reported complete hair loss from liposomal doxorubicin + carboplatin.

If reading the clinical study, liposomal doxorubicin (Doxil®) is also referred to as Pegylated Liposomal Doxorubicin, or “PLD”. 

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingAnemiaAnemiaConstipationConstipationPainPainBleedingBleedingHair LossHair LossDiarrheaDiarrheaNeutropenic FeverNeutropenic Fever

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and inbetween treatments if necessary. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), CA-125, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment and periodically during treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. An electrocardiogram (EKG or ECG) and echocardiogram (Echo) or multiple-gated acquisition (MUGA) scans are typically performed to check heart function prior to starting treatment and every 3 to 6 months during treatment.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue liposomal doxorubicin + carboplatin as planned, or delay or switch therapy.

ChemoExperts Tips

  • Carboplatin hypersensitivity reaction can be severe. This reaction is most common around the 8th or 9th treatment, but can happen after any dose. Some institutions may use "desensitization protocols" to allow a person to keep receiving carboplatin after they have had a reaction. Desensitization is used if someone is receiving a good response from carboplatin, or if few other chemotherapy drug options are available
  • Infusion reactions may occur during treatment with liposomal doxorubicin and occur in up to 11% of patients. Common symptoms include shortness of breath, swelling of the face, headache, chills, back pain, chest pain, and low blood pressure. The infusion may need to be temporarily stopped and medications may need to be given if a reaction occurs
  • Patients and their caregivers should be counseled to recognize the signs and symptoms of drug reactions and report them immediately, even after they have left the clinic
  • Tell your nurse immediately if you notice any burning, stinging, or swelling around the area where the infusion is being administered as this could mean that the drug is not staying in the vein. This is known as “extravasation,” and can damage the surrounding skin and muscle tissue
  • Painful redness, blistering, and peeling skin reaction on the palms of your hands and on the soles of your feet may develop. This is known as Hand-Foot Syndrome. Ways to help reduce the risk of experiencing Hand-Foot Syndrome include using a non-alcoholic moisturizer daily on your hands and feet, avoid wearing gloves, avoid prolonged exposure to hot water, and avoid activities that put pressure or friction on your hands and feet such as golf or tennis while being treated with liposomal doxorubicin
  • May cause secondary cancers of the mouth that can develop during treatment or up to 6 years after treatment is complete. This is most often seen in patients being treated with liposomal doxorubicin for a year or longer
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for ovarian cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Liposomal Doxorubicin (Doxil®) + Carboplatin, we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Liposomal Doxorubicin (Doxil®) + Carboplatin. Depending upon your income, they may be able to help cover the cost of:

  • Liposomal Doxo­rubicin
  • Carboplatin

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Liposomal Doxorubicin (Doxil®) + Carboplatin and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Liposomal Doxorubicin (Doxil®) + Carboplatin

Individual Drug Label Information

Liposomal Doxo­rubicin (Doxil®)

  • ​Is an intravenous (I.V.) infusion that is red in color 
  • Dosage adjustments may be needed for liver toxicity, low white blood cells, low platelets, or severe side effects 
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions  
  • May interact with grapefruit and grapefruit juice, star fruit, pomegranate juice, or Seville oranges found in marmalade (other citrus fruit are okay to eat). These cause increased blood levels of liposomal doxorubicin which could increase your risk of experiencing side effects. It is best to avoid eating or drinking anything containing these fruits or their juices during treatment 
  • Avoid therapy with St. Johns Wort as it will decrease blood levels of liposomal doxorubicin. This could decrease the effectiveness 
  • Can affect heart function. A heart study (echocardiogram or MUGA scan) may be required before receiving the first dose 
  • Infusion reactions may occur. Examples of this may include: flushing or facial swelling, shortness of breath, chest or throat tightness, headache, chills, or back pain. The infusion may need to be temporarily stopped and medications may need to be given if a reaction occurs 
  • May cause secondary cancers of the mouth that can develop after long-term treatment (usually after one year), but the risk may continue for up to 6 years after treatment is complete 
  • Can cause painful redness, swelling, and blisters on palms of hands and soles of feet known as Hand-Foot Syndrome 
  • Liposomal doxorubicin may cause harm to an unborn baby if given to a pregnant woman. It is not known if liposomal doxorubicin is excreted in human breast milk 
  • Women and men should use effective contraception during treatment and for 6 months after the last treatment
General side effects from liposomal doxorubicin (Doxil®):
  • Weakness or fatigue 
  • Fever 
  • Decreased appetite 
  • May cause low red blood cells, white blood cells, and platelets 
  • Gastrointestinal symptoms such as nausea/vomiting, constipation or diarrhea are common 
  • Mouth sores 
  • Hair loss 
  • Rash 
  • May temporarily turn urine orange 
  • Leakage into skin or surrounding muscle during infusion may cause severe irritation (extravasation) 
  • Click on the liposomal doxorubicin (Doxil®) package insert below for all reported side effects and possible drug interactions 

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Carboplatin (Paraplatin®)

  • Carboplatin is an intravenous infusion 
  • This medication is dosed based on your kidney function. If your kidney function improves or worsens during therapy, your dose may need to be adjusted
  • This drug should not be used during pregnancy, it may cause fetal harm
General Carboplatin (Paraplatin) Side Effects:  
  • Low red blood cells, low white blood cells, and most commonly, low platelets can be occur
  • Nausea and vomiting is common but can be prevented by taking certain pre-medications
  • Hair loss
  • Constipation and/or diarrhea
  • Pain
  • Allergic reactions to carboplatin can occur. These typically are not seen until after the 6th dose of carboplatin is given 
  • Can cause liver damage at high doses 
  • May cause kidney damage or hearing loss if combined with other medications that also cause these side effects 
  • Click on the carboplatin (Paraplatin) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossBleedingBleedingConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

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References

1) Pujade-Lauraine E, Wagner U, Aavall-Lundqvist E, et al. Pegylated Liposomal Doxorubicin and Carboplatin Compared With Paclitaxel and Carboplatin for Patients With Platinum-Sensitive Ovarian Cancer in Late Relapse. J Clin Oncol 2010;28(20):3323-9.

Created: March 7, 2017 Updated: March 7, 2017

What is Ovarian Cancer?

What is Ovarian Cancer?
A disease of the cells found in the ovaries in women. Ovarian cancer is not common, but is the fifth leading cause of cancer related death in women. The exact cause is not known, however risk factors include: older age, obesity, first period at an early age, late menopause, hormone replacement therapy (HRT) after menopause, family history, and genetic causes such as the BRCA (pronounced "bracka") mutation. The use of oral contraceptives or having one or more full-term pregnancies can decrease the risk of ovarian cancer.

The stage of ovarian cancer can vary at diagnosis and throughout treatment. Ovarian cancer is staged using the Tumor, Node, Metastasis (TNM) staging system, as well as Stage Grouping I, II, III, or IV. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

What does LVEF mean?

Left Ventricular Ejection Fraction - The amount of blood pumped by the left ventrical (chamber) of the heart into the body with each heartbeat.  Certain drugs can decrease heart function and result in less blood being pumped by each heartbeat than normal.

What is an "anthracycline" drug?

A class of chemotherapy agents that include doxorubicin (liposomal and conventional), daunorubicin, idarubicin, and epirubicin. All of these chemotherapy agents can cause heart problems such as heart failure and the risk increases as more treatments with these medicines are given.

Common starting doses of liposomal doxorubicin (Doxil) + Carboplatin

Liposomal doxorubicin (Doxil®) 30 mg/m2 intravenous (I.V.) infusion on Day 1.

  • During Cycle 1, the infusion rate varies for each patient, but is usually started at 1 mg/min. Therefore, if your Doxil dose is greater than 60 mg, the first dose may take more than one hour
  • If no infusion reactions occur with the first infusion, subsequent doses may be infused over one hour

Carboplatin AUC 5, I.V. infusion over 30 minutes on Day 1

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium