Medical Pharmacology Chapter 33-34: Anticancer Drugs
Topoisomerase Inhibitors Type II: Daunorubicin (Cerubidine)
Historically, doxorubicin was the initial drug in the anthracycline class isolated.3
A prominent source of this agent and doxorubicin is Streptomyces peucetius (variation caesius).
Daunorubicin is often a component of the chemotherapy induction phase protocol for treating acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL).8
For AML, daunorubicin may be employed in combination with ara-C (cytarabine).1
Differing from doxorubicin, daunorubicin exhibits limited effectiveness in treating solid tumors.3
Daunorubicin, following IV infusion, exhibits rapid plasma clearance (principal half-life: 40 minutes).8
Doxorubicin exhibits hepatic metabolism and depends on the kidneys for drug elimination.
In patients with hepatic and renal dysfunction, daunorubicin doses would be typically reduced.
The criteria for dose reduction depends on either serum creatinine or bilirubin levels.
For a 50% dose reduction, for example, serum creatinine or bilirubin would be > 3 mg/dL.
A dose reduction by 25% may be recommended for bilirubin concentrations in the range of about 1.2 to 3.0 milligrams/dL.
The parent compound (daunorubicin) is extensively metabolized with prominent glucuronide forms found in the bile (phase II metabolism).
An alcohol metabolite is prominently noted following bolus doxorubicin administration and exhibits an extended half-life compared to the parent compound.
By contrast to doxorubicin, daunorubicin metabolism is an important characteristic of plasma pharmacology.8
Daunorubicin is mainly used in treating acute leukemias, acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL).7
In the pediatric setting, acute lymphoblastic leukemia may be treated using daunorubicin (IV route of administration) in combination treatment with prednisone and vincristine.7
Daunorubicin toxicity profiles are generally similar to that described earlier for doxorubicin.
These toxicities include:
Daunorubicin is a notable vesicant.