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 breast cancer diet during Adriamycin chemotherapy for information on how various foods and micronutrients influence Adriamycin treatment.
Adriamycin and prescription or over-the-counter drugs
A few drugs 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. Statins have also been shown to protect against Adriamycin-induced heart damage. 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. Aspirin also has the potential to interfere with chemotherapy. Naproxen (Aleve) has been shown to increase Adriamycin-induced heart damage (cardiomyopathy). Use of ibuprofen (Advil, Motrin) has been found to be associated with increased risk of hormone receptor positive (ER+/PR+) breast cancer, although we are not aware of research specifically regarding any interactions with Adriamycin. Acetaminophen (Tylenol) appears to be the best choice while on Adriamycin.
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, 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 breast cancer diet during Adriamycin chemotherapy. However, safe and effective dosages for these supplements during chemotherapy have not been established. 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). Another study reported that while quercetin reduced the heart damage associated with Adriamycin treatment, it reduced its efficacy in some breast cancer cell lines. Therefore, we suggest obtaining these compounds by consuming food rather than taking them in concentrated form, which could have unintended adverse effects.
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.
Light at night
Recent evidence suggests that habitually sleeping in the presence of artificial light, even dim light, can reduce the effectiveness of Adriamycin treatment. Light suppresses the production of melatonin, a hormone which can inhibit tumor proliferation. Blue light wavelengths appear to have a far greater suppressive effect on melatonin production than red wavelengths. Melatonin levels can be increased by consuming foods that incorporate melatonin. Common foods that are very good dietary sources of melatonin include almonds, cherries (especially sour or tart cherries), and tomatoes. However, note that safe and effective dosages of melatonin supplements for breast cancer patients have not been established.
High levels of iron or ferritin (a molecule that stores iron) can reduce the cytotoxic treatment effects of Adriamycin. In addition, Adriamycin-induced heart damage has been linked to mitochondrial iron accumulation — reducing mitochondrial iron levels has been shown to protect against Adriamycin-induced cardiomyopathy.
Many women undergoing chemotherapy develop abnormally low iron levels. Since blood counts usually are monitored during chemotherapy, these women will be identified and treated. However, based on the available evidence, women on Adriamycin without low iron levels should avoid iron supplements (including those in multivitamins), as well as sources of heme iron (from animal sources) such as red meat or any type of liver. The body absorbs heme iron more effectively than nonheme iron from plant sources such as spinach and dry beans. Tumeric contains curcumin, which has been shown to be an iron chelator, which may be helpful in reducing iron stores.
Nicotine has been shown to reduce the effectiveness of Adriamycin in ER+/PR+ breast cancer cells, increasing the proportion of breast cancer stem cells. This suggests that smoking and other nicotine delivery mechanisms such as vaping should be avoided.
Obesity has been shown to reduce the effectiveness of Adriamycin. For example, one 2019 study reported that breast cancer cells that were co-cultivated with fat cells were found to develop increased resistance to Adriamycin, independent of the breast cancer subtype.
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 radiotherapy 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.
Below are links to recent studies on this topic. For a more complete list of studies, please click on Adriamycin.