Liposomal daunorubicin is a chemotherapy drug that is given to treat Aids-related Kaposi's sarcoma. It is also commonly used to treat specific types of leukaemia and non-Hodgkin lymphoma. This information describes the drug, how it is given and some of the possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give more information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Liposomal daunorubicin is a chemotherapy drug. The molecules of the drug are enclosed (encapsulated) in a fatty coating known as a liposome. The liposome allows the daunorubicin to circulate in the body for longer so that more of the chemotherapy is delivered to the cancer cells, whilst having fewer side effects on healthy tissue.

Liposomal daunorubicin is a red fluid.

Liposomal daunorubicin is usually given by a drip (infusion):

• through a fine tube inserted into the vein (cannula)
• through a central line which is inserted under the skin into a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of your arm.

The infusion usually takes about 60 minutes.

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects while others experience more. The side effects described in this factsheet will not affect everyone having liposomal daunorubicin chemotherapy.

We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects which you think may be due to the drug but which are not listed in the factsheet, please let your nurse or doctor know.

Lowered resistance to infection Liposomal daunorubicin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, while your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38 °C (100.5 °F)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Liposomal daunorubicin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with liposomal doxorubicin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these symptoms are a problem.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Sore mouth and ulcers Your mouth may become sore or you may notice small ulcers during this treatment. Tell your doctor if you have any of these problems as they can prescribe special mouthwashes and medicine to prevent or clear any mouth infection. Using a soft toothbrush may be helpful.

Taste changes You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

Hot flushes or backache Some people may experience hot flushes or backache while the drug is being given. A mild painkiller such as paracetamol can be helpful to relieve backache.

Discoloured urine Your urine may become a pink-red colour. This can last up to 48 hours after you have been given liposomal daunorubicin and is due to the colour of the drug. It is quite normal.

Sensitivity to the sun While you are having liposomal daunorubicin, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but always wear a high protection factor suncream, protective clothing and a hat.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try and get as much rest as you need.

Allergic reaction Signs of an allergic reaction can include hot flushes, backache and a feeling of tightness in the chest. Let your nurse know straight away if you experience any of these. The nurse will stop the drip and the symptoms will gradually go. The drip will then be restarted and there are usually no further allergic reactions.

Changes in the way your heart works High doses of this drug may cause changes in the muscle of the heart, which can affect how the heart works. The effect on the heart depends on the dose given. It is very unusual for the heart to be affected if you have standard doses. Tests to see how well your heart is working may sometimes be carried out before the drug is given.

Hair loss Some people may experience hair loss. Hair may be lost completely or just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and all your hair will start to grow again once the treatment is finished.

Diarrhoea This can usually be easily controlled with medicine but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Leakage into the tissue If liposomal daunorubicin leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or chemotherapy nurse.

If the area around the injection site becomes red or swollen you should either tell the doctor on the ward or, if you are at home, ring the clinic or ward and ask for the doctor or nurse.

Some people have a red flush or itching along the vein while the drug is being given.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy (including those that you can buy from a shop or chemist). Always tell your doctor about any medicine you are taking, including herbal and complementary therapies.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking this treatment as it may harm the developing foetus. It is important to use effective contraception whilst taking these drugs, and for at least a few months afterwards. Again discuss this with your doctor.

This section is based on our liposomal daunorubicin factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al, Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website – www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry, Lippincott Williams and Wilkins, 2001.

For further references, please see general bibliography.