See a discussion of the clinical usefulness of Doxil, Cancer Invest. 2001;19(4):424-36. Although Doxil is less toxic in many ways, the prior clinical history of treating various tumors with doxorubicin has led to the latter's approval for many targets. It's not necessary for drugs to be rigorously clinically tested, formally approved, and so labeled for *all* uses by doctors; doctors frequently use drugs for 'off-label" uses. It's extremely expensive to generate additional labeling approvals for a drug! Therefore, a new drug may be initially tested and approved for a small segment of its potential market. Thereafter, what form of a drug is used may depend on its labeling, the current medical community's experience with it, its side effects, the condition of the patient, and possibly also the cost or affordability of that form, among other factors.

Thank you very much, Mr. de Riel, it helped me to find what I needed. ;)

Dear Michaela,

Your question is very pertinent. The answer, however, is very simple- Pure Health Economics. A generic formulation of doxorubicin costs £20.60 for a 10mg vial while the liposomal preparation costs £712.44 for a 2mg i.e. £3560 for 10mg. In other words, it is 175 times more expensive. So the clinicians and healthcare providers have to decide whether its enormous cost is justified for routine use. Difficult to convince unless you have limitless finances.

Dear Dr. Sivakumaran,

Thanks a lot for your helpful answer. I thought that the main aspects limiting its usage will be more of economic nature than scientific, however I didn´t find any source discussing these practical aspects. Anyway, I was not sure, since there are already approved generics available, so I though this is not such a big problem anymore. Thank you very much.

I think that given what we know about the pharmacology of doxorubicin and Doxil, it is clear hat one should use Doxil: no hairloss, no cardiac toxicity, no risk of vesicant damage, given once every 4 weeks, possibility of treating for long periods of time, and same (or better) antitumor efficacy. Also, it combines well with cyclophosphamide and with platinum-based agents, and of course with aminobisphoshonates (zoledronic acid). It does not make any sense to wait until you reach 300 mg/m2 cumulative free doxorubicin to start on Doxil. It is a ridiculous requitement which shoud have been removed long ago. I use Doxil first line in MBC patients, and, in a few patients, I have used Doxil as adjuvant, although the latter is a more complex issue.