Pharmacokinetics, Biodistribution and Therapeutic Efficacy of Doxorubicin Encapsulated in Stealth® Liposomes (Doxil®)

Doxil® (Stealth® liposomal doxorubicin HCl) Injection is doxorubicin HCl incorporated into long circulating liposomes that contain surface-grafted polyoxyethylene chains. These surface-grafted polymer chains reduce the interaction of the liposomes with the mononuclear phagocytic system, accounting for the long circulation and altered biodistribution of Stealth liposomes. They also reduce adhesion of the liposomes to cells, blood vessel walls and other surfaces and result in increased vascular permeability of Stealth liposomes compared to conventional liposomes of equal size. Efficacy studies in several tumor models, including human xenograft models, have demonstrated that Doxil is more effective than unencapsulated doxorubicin (Adriamycin) or doxorubicin encapsulated in non-coated conventional liposomes. Doxil exhibits altered plasma pharmacokinetics, with a longer plasma half-life, large AUC and markedly smaller volume of distribution than Adriamycin. Tissue levels of doxorubicin are generally lower in Doxil-treated animals than in animals that receive an equivalent dose of Adriamycin, and Doxil is less cardiotoxic, myelotoxic and nephrotoxic than Adriamycin. Phase I and II studies evaluating the efficacy of Doxil in AIDS-related Kaposi sarcoma have been encouraging, with evidence of increased delivery of drug to the lesions and an overall good response to therapy. The increased efficacy of Doxil is believed to be related to its increased extravasation through the leaky tumor vasculature and its accumulation in tumor tissue.