Daunorubicin hydrochloride and Renal dysfunction

• Generic Name: daunorubicin
• Dosage Forms: n.a.
• Other Brand Names: Cerubidine

Conventional daunorubicin hydrochloride: Remission induction (in combination with other antineoplastic agents) in childhood or adult ALL.

In non-high-risk childhood ALL, combination therapy with an asparaginase preparation, a corticosteroid (dexamethasone or prednisone), and vincristine is used as an induction regimen. Intensive induction regimens with ≥4 drugs, including an anthracycline (e.g., daunorubicin), an asparaginase preparation, a corticosteroid, and vincristine, with or without cyclophosphamide, may improve event-free survival but cause greater toxicity. Some clinicians reserve 4- or 5-drug regimens for patients with high-risk childhood ALL; others elect to use such regimens for all patients with childhood ALL regardless of presenting features.

In adults, induction regimens typically include an anthracycline, vincristine, and prednisone; some regimens also add other drugs (e.g., an asparaginase preparation, cyclophosphamide).

Various regimens have been used in combination therapy, and comparative efficacy is continually being evaluated.

Other regimens are preferred in certain subsets of patients with ALL (e.g., B-cell ALL, T-cell ALL, Philadelphia chromosome-positive ALL); consult specialized references and experts for additional information.

Conventional daunorubicin hydrochloride: Used in combination with other antineoplastic agents for the treatment of AML in adults. Cytarabine with either daunorubicin or idarubicin is a regimen of choice for remission induction in AML.

Consolidation chemotherapy typically consists of a cytarabine-based regimen similar to that used in induction therapy administered over a short-term period following induction of complete remission. Duration of consolidation chemotherapy has ranged from one to ≥4 cycles; however, optimal consolidation chemotherapy regimen (including dosage, schedules, and duration) not established. Maintenance therapy for AML generally not recommended.

Conventional daunorubicin hydrochloride: Has been used with other antineoplastic agents in the treatment of accelerated or blast-phase CML.

Liposomal daunorubicin citrate: First-line therapy for advanced AIDS-related Kaposi’s sarcoma; not recommended for early stages of the disease. Liposomal anthracycline (daunorubicin or doxorubicin) is the first-line therapy of choice for advanced AIDS-related Kaposi’s sarcoma.

Comparative efficacy of liposomal daunorubicin citrate relative to liposomal doxorubicin not established, but liposomal daunorubicin appears to be better tolerated than and comparably effective to combination chemotherapy (e.g., conventional doxorubicin, bleomycin, and vincristine) for the management of advanced AIDS-related Kaposi’s sarcoma.