Many breast cancer patients who undergo chemotherapy are given Adriamycin (doxorubicin) as part of their regimen. Chemotherapy is designed to destroy any remaining cancer cells in the breast and the remainder of the body before or after surgery. Chemotherapy is effective in improving breast cancer survivorship; numerous studies have found that it protects against breast cancer recurrence and metastases in other organs of the body.

Adriamycin, which is an anthracycline, can result in side effects such as hair loss, bone marrow suppression, nausea, fatigue, hand-foot syndrome, cognitive impairment ("chemo brain"), serious infections and heart damage. However, it is important for breast cancer patients to avoid consuming foods that will lessen the cytotoxic effects of Adriamycin on cancer cells. Compounds that provide relief from chemotherapy side effects may also provide some protection to breast cancer cells from the toxic effects of the treatment. Please see our article on what to eat while on Adriamycin chemotherapy for information on how various foods and micronutrients influence Adriamycin treatment.

Adriamycin and prescription drugs

A few prescription drugs and supplements have been studied with respect to their interaction with Adriamycin. Metformin, a drug used to treat type 2 diabetes, has been shown to enhance the effectiveness of Adriamycin. Statins (lipid-lowering drugs that block cholesterol synthesis) and proton pump inhibitors (used to treat acid reflux) also appear to enhance Adriamycin's cytotoxic effects or at least not to interfere with the treatment. One study reported that the anti-diarrhea drug Imodium (loperamide) can reverse resistance to Adriamycin treatment in breast cancer cells. On the other hand, Celebrex, an NSAID which is used to reduce inflammation and arthritis pain, has been shown to interfere with Adriamycin's cytotoxic effects in breast cancer cells.

Adriamycin and supplements

Taking multivitamins during chemotherapy might help protect cancer cells from the toxic effects of the treatment and we do not recommend it. Other micronutrients such as curcumin, quercetin, luteolin, and resveratrol have been studied and found to increase the effectiveness of Adriamycin in laboratory experiments. The relevant studies are presented in our article on what to eat during Adriamycin chemotherapy. However, safe and effective dosages for these supplements during chemotherapy have not been established. We suggest obtaining these compounds by consuming food rather than taking them in concentrated form, which could have unintended adverse effects. For example, one study reported that resveratrol alone promoted mammary tumor growth and metastasis in a mouse model of estrogen receptor negative (ER-) breast cancer whereas it inhibited it in combination with quercetin and catechin (all three flavonoids are found in red grapes).

Milk thistle, a relative of artichoke, traditionally has been used for its liver-protective properties, but increasingly is being used by cancer patients. Milk thistle is the best known source of the compound flavonoid silymarin, which contains silybin. Silybin has been shown to inhibit growth and induce apoptosis in human breast cancer cells and HER-2/neu overexpressing (HER2+) mammary tumors in a mouse model. However, one study found that treatment of human breast cancer tumors in rodents with silymarin isolated from milk thistle stimulated cancer growth. Therefore, we caution breast cancer patients against taking concentrated milk thistle, artichoke or silymarin supplements.

While consuming fatty fish such as salmon is recommended during Adriamycin treatment, recent research suggests that fish oil supplements should not be used by those undergoing chemotherapy. Some fish oil preparations contain fatty acids that can induce resistance to a broad spectrum of chemotherapy drugs in minute quantities.

Note that curcumin (found in turmeric) has been shown to be an iron chelator, which could negatively impact some women undergoing chemotherapy by reducing their iron stores.

Exercising during Adriamycin chemotherapy

Adriamycin typically causes muscle weakness, including diaphragm muscle weakness, which can contribute to shortness of breath and exercise intolerance. Aerobic exercise has been shown to protect heart muscle against the detrimental side effects of Adriamycin treatment on cardiac tissue in animal studies. It also can assist in maintaining overall physical conditioning, reduce fatigue, help prevent weight gain, and improve mood.

However, intense exercise during chemotherapy could interfere with treatment effectiveness. One study compared the outcomes of Adriamycin-treated mice who were exercised or not. Moderate-intensity endurance exercise did not significantly influence Adriamycin-induced mammary tumor growth inhibition. However, there was a trend for longer survival for mice treated with Adriamycin only, suggesting that exercise training inhibited Adriamycin's efficacy. Another study reported that intense or prolonged physical activity a couple of days before the start of radiation or chemotherapy has significant potential to reduce the benefits of the treatments.

Based on the available evidence, light to moderate aerobic exercise appears beneficial during treatment with Adriamycin, but heavy or prolonged exercise should be avoided.