Adriamycin (doxorubicin) chemotherapy is effective in improving breast cancer survivorship: numerous studies have found that it protects against breast cancer recurrence and metastases. Adriamycin can result in side effects such as hair loss, bone marrow suppression, nausea, fatigue, hand-foot syndrome, cognitive impairment (chemo brain) and serious infections.
The most serious potential side effect is heart damage (cardiomyopathy), which can lead to heart failure. Patients with BRCA mutations appear to be particularly susceptible to Adriamycin-induced cardiomyopathy.
It is important for breast cancer patients to avoid consuming foods or taking supplements that will lessen the cytotoxic impact of Adriamycin on cancer cells. Compounds that provide relief from chemotherapy side effects may also provide some protection to breast cancer cells. In fact, while various micronutrients found in fruits, vegetables and other foods have been shown to help protect against breast cancer development and metastasis, some micronutrients might enable breast cancer cells to survive chemotherapy.
The goal should be to eat a healthy diet that meets nutritional needs while avoiding harmful foods that can promote breast cancer. It is more important to avoid unhealthy foods (fast food, junk food, meals consisting mostly of highly refined carbohydrates, unhealthy fats (including most vegetable oils), red meat, fried food) than to consume cancer-fighting foods. The purpose of food during chemotherapy is to enable patients to feel well enough to continue treatment, not to eliminate side effects that may in fact be associated with successful treatment.
One 2019 study reported that the presence of fat cells promoted resistance to Adriamycin chemotherapy in a wide variety of human and mouse breast cancer cells. Clearly, weight gain, which is common among breast cancer patients undergoing chemotherapy, should be avoided. However, weight loss is also associated with unfavorable prognosis in women undergoing anthracycline chemotherapy and should not be a goal during treatment.
There are a few foods that have been shown to act synergistically with Adriamycin to enhance its effectiveness against breast cancer or to protect against heart damage without interfering with the treatment. The strategy we recommend during chemotherapy and for the following month is to consume the foods that enhance the effectiveness of Adriamycin, as well as those on the neutral food list (listed later in this article), while limiting or avoiding the foods that should not be consumed while on Adriamycin, as well as those on our general avoid list. Please see our webpage on factors influencing Adriamycin effectiveness for non-food influences on Adriamycin treatment.
Foods that enhance effectiveness of Adriamycin or safely reduce side effects
The following foods are very good sources of compounds that have been shown to increase the anti-cancer effects of Adriamycin or reduce its side effects without interfering with treatment:
Fruits and vegetables should be washed thoroughly before cooking or consuming. This includes the exterior of fruits such as watermelon since cutting through the rind can transfer bacteria such as salmonella to the flesh.
- Arctic char
- Bell peppers
- Black cumin
- Black pepper
- Bok choy, or Chinese cabbage
- Brazil nuts
- Brussels sprouts
- Butternut squash
- Celery & celery hearts
- Cherries, both regular & sour
- Cranberries & lingonberries
- Currants, black
- Flaxseed & flaxseed oil
- Grape seed oil
- Grapes, red & grape juice
- Horseradish & wasabi
- Hot peppers
- Lettuce, romaine
- Mushrooms, excluding reishi mushroom
- Olive oil, extra-virgin
- Olives, black & green
- Onions, all types
- Pomegranates & pomegranate juice
- Rice, brown, black or red
- Salmon, wild
- Squash, winter
- Turnips & turnip greens
- Walnut oil
- Watercress & garden cress
Brazil nut consumption should be limited to no more than one nut per day, on average, to avoid consuming excess selenium.
Topical application of honey has been shown to be effective in reducing the severity of chemotherapy-induced oral mucositis.
Many women develop abnormally low iron levels during chemotherapy which must be treated. However, excess iron is also to be avoided since it has been shown to reduce the effectiveness of Adriamycin. Curcumin (found in turmeric) has been shown to be an iron chelator (a compound that removes iron from the body) as well as a copper chelator. Turmeric might also protect the brain from chemotherapy, thereby reducing chemo brain. In addition, curcumin has been shown to reduce cardiomyopathy in a mouse model of Adriamycin treatment.
Supplements for patients being treated with Adriamycin
There is no supplement or combination of supplements that has been proven to reliably reduce the risk of breast cancer recurrence in women. Attempting to take advantage of the apparent treatment effects of micronutrients and other dietary components by using supplements carries the risk of adverse and paradoxical effects, including promoting breast cancer growth and metastasis.
What is known is that when a beneficial micronutrient is administered at low doses by consuming food, it is likely to have subtle chemopreventive effects, whereas when the same micronutrient is administered at high doses, it is more likely to have pharmacological effects, with mostly unknown results. Therefore, it is best to obtain beneficial compounds by consuming food, if possible. The role of supplements is to make up for deficiencies that are difficult to correct through diet.
The following supplements generally have been found to be safe and beneficial for those being treated with Adriamycin:
Avoid taking supplements during the two days before, the day of, and the day after each chemotherapy treatment. Please consult your oncology team for advice concerning your situation and dosages. It might make sense to be tested for deficiency in vitamin D and plan for follow up to determine if your reading has reached a desirable level.
Foods that should be limited or avoided while on Adriamycin
The following foods have been found to interfere with the effectiveness of treatment with Adriamycin:
Supplements & other products that should not be used on Adriamycin
The following vitamins, supplements and other products have been found to interfere with the effectiveness of Adriamycin. That is not to say that most other supplements are safe to take; there are no relevant scientific studies concerning the interactions between most supplements and Adriamycin.
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.
- Apigenin supplements
- Artichoke supplements
- Caffeine, any source
- Genistein, daidzein or equol supplements
- Goldenseal supplements
- Green tea and EGCG supplements
- Iron supplements (unless medically necessary)
- Licorice root supplements
- Milk thistle, silybin or silymarin supplements
Hesperidin and saffron could reduce effectiveness of cyclophosphamide
Hesperidin, a flavonoid found in oranges, tangerines, kumquats, lemons, limes and grapefruit, has the potential to interfere with chemotherapy regimens containing cyclophosphamide, such as TAC (Taxotere, Adriamycin and cyclophosphamide). Cyclophosphamide is an alkylating agent frequently used in combination with anthracyclines (Adriamycin, epirubicin) and/or taxanes (Taxol, Taxotere). Hesperidin is found most abundantly in the peel, pith and membranous parts of oranges and other citrus fruits. Prepared food sources include orange tea, commercial orange juice, orange marmalade, and dishes that incorporate citrus peel such as Szechuan Orange Chicken. See oranges for more information.
Saffron, vitamin A, vitamin B12, vitamin C and vitamin E supplements also have the potential to interfere with the treatment effects of cyclophosphamide.
Neutral foods for use during Adriamycin chemotherapy
We have provided the list below in order to increase the number of foods that can be consumed while on Adriamycin. It includes some foods for which we do not have enough information to put on our recommended list, but that do not appear to promote breast cancer or interfere with Adriamycin treatment (when consumed in moderation). It is important not to drive up blood sugar and insulin levels with high carbohydrate/low fiber meals. Consume the foods below in moderation, but concentrate on the foods recommended above.
Food should not be deep fried, barbequed, pan fried at high heat, roasted or smoked. The best cooking methods for starchy foods are steaming, boiling and baking. Very little salt should be used in preparing food.
BPA and BBP can interfere with effectiveness of Adriamycin chemotherapy
Bisphenol A (BPA), an endocrine disruptor, is suspected of increasing the risk of breast cancer. BPA at low concentrations has been shown to reduce the efficacy of Adriamycin in both estrogen receptor positive (ER+) and triple negative (ER-/PR-/HER2-) breast cancer cells. BPA exposure can be limited by avoiding canned foods, canned sodas, and polycarbonate plastic bottles and food containers, which may be marked with a 7 or 3 recycling number in a triangle-shaped icon (normally found on the base).
The phthalate BBP (benzyl butyl phthalate) has been shown to increase resistance to Adriamycin (doxorubicin) plus cyclophosphamide chemotherapy regimens. BBP is used in making vinyl floor tiles, carpet backing, car trims and dashboards, as well as artificial leather. It is also added to some adhesives, perfumes, and hair sprays.
Weight loss and weight gain during chemotherapy
Recent studies suggest that fasting around chemotherapy treatments could protect normal cells from the toxic effects of chemotherapy while sensitizing cancer cells to the treatment. However, a study in which rats were deprived of protein during anthracycline chemotherapy found that protein malnutrition reduced the elimination of both Adriamycin and epirubicin, prolonging the exposure of the heart to the drugs and increasing the anthracycline-associated heart damage. More studies and human trials are required before it can be determined whether fasting during chemotherapy is safe and effective.
On the other hand, weight gain, which is common during chemotherapy, is known to be associated with less favorable prognosis and should be avoided.
Exercise during chemotherapy
Regular exercise has been shown to reduce fatigue in cancer patients undergoing chemotherapy. However, one study suggested 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 to be safe during treatment with Adriamycin and could help preserve heart health and reduce fatigue.
Please see our article on how to optimize your breast cancer diet for information on what to eat during all stages of treatment and recovery. Below are links to recent studies on Adriamycin and breast cancer. For a more complete list of studies, please click on the tag Adriamycin.
Selected breast cancer studies
Apigenin ameliorates doxorubicin-induced renal injury via inhibition of oxidative stress and inflammation
Wu Q, Li W, Zhao J, Sun W, Yang Q, Chen C, et al. Apigenin ameliorates doxorubicin-induced renal injury via inhibition of oxidative stress and inflammation. Biomedicine & Pharmacotherapy. Elsevier BV; 2021; 137:111308 10.1016/j.biopha.2021.111308
Luteolin attenuates doxorubicin-induced derangements of liver and kidney by reducing oxidative and inflammatory stress to suppress apoptosis
Owumi S, Lewu D, Arunsi U, Oyelere A. Luteolin attenuates doxorubicin-induced derangements of liver and kidney by reducing oxidative and inflammatory stress to suppress apoptosis. Human & Experimental Toxicology. SAGE Publications; 2021;:096032712110061 10.1177/09603271211006171
Effect of thymoquinone-loaded lipid–polymer nanoparticles as an oral delivery system on anticancer efficiency of doxorubicin
Moghaddam FA, Ebrahimian M, Oroojalian F, Yazdian-Robati R, Kalalinia F, Tayebi L, et al. Effect of thymoquinone-loaded lipid–polymer nanoparticles as an oral delivery system on anticancer efficiency of doxorubicin. Journal of Nanostructure in Chemistry. Springer Science and Business Media LLC; 2021; 10.1007/s40097-021-00398-6
Resveratrol as Chemosensitizer Agent: State of Art and Future Perspectives
Cocetta V, Quagliariello V, Fiorica F, Berretta M, Montopoli M. Resveratrol as Chemosensitizer Agent: State of Art and Future Perspectives. International Journal of Molecular Sciences. MDPI AG; 2021; 22:2049 10.3390/ijms22042049
Antioxidant and Anti-Inflammatory Effects of Crocin Ameliorate Doxorubicin-Induced Nephrotoxicity in Rats
Hussain MA, Abogresha NM, AbdelKader G, Hassan R, Abdelaziz EZ, Greish SM. Antioxidant and Anti-Inflammatory Effects of Crocin Ameliorate Doxorubicin-Induced Nephrotoxicity in Rats. Oxidative Medicine and Cellular Longevity. Hindawi Limited; 2021; 2021:1-12 10.1155/2021/8841726
CAN ANTIOXIDANT VITAMINS AVOID THE DOXORUBICIN CARDIOTOXICITY IN THE BREAST CANCER TREATMENT?
Lima Cavalcanti ID, Santos Soares JC, de Fátima Ramos dos Santos Medeiros SM, Ferro Cavalcanti IM, de Britto Lira Nogueira MC. CAN ANTIOXIDANT VITAMINS AVOID THE DOXORUBICIN CARDIOTOXICITY IN THE BREAST CANCER TREATMENT?. PharmaNutrition. Elsevier BV; 2021;:100259 10.1016/j.phanu.2021.100259
Ursolic Acid Enhances Cytotoxicity of Doxorubicin-Resistant Triple-Negative Breast Cancer Cells via ZEB1-AS1/miR-186-5p/ABCC1 Axis
Lu Q, Chen W, Ji Y, Liu Y, Xue X. Ursolic Acid Enhances Cytotoxicity of Doxorubicin-Resistant Triple-Negative Breast Cancer Cells via ZEB1-AS1/miR-186-5p/ABCC1 Axis. Cancer Biotherapy and Radiopharmaceuticals. Mary Ann Liebert Inc; 2021; 10.1089/cbr.2020.4147
Clinical applicability of natural products for prevention and treatment of oral mucositis: a systematic review and meta-analysis
Lima ICGdS, de Fátima Souto Maior L, Gueiros LAM, Leão JC, Higino JS, Carvalho AAT. Clinical applicability of natural products for prevention and treatment of oral mucositis: a systematic review and meta-analysis. Clinical Oral Investigations. Springer Science and Business Media LLC; 2021; 10.1007/s00784-020-03743-1
Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer: A Mixed‐Methods Study
Kruif AJ, Westerman MJ, Winkels RM, Koster MS, Staaij IM, Berg MMGA, et al. Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer: A Mixed‐Methods Study. Journal of Human Nutrition and Dietetics. Wiley; 2021; 10.1111/jhn.12843
Melatonin prevents doxorubicin-induced cardiotoxicity through suppression of AMPKα2-dependent mitochondrial damage
Yang G, Song M, Hoang DH, Tran QH, Choe W, Kang I, et al. Melatonin prevents doxorubicin-induced cardiotoxicity through suppression of AMPKα2-dependent mitochondrial damage. Experimental & Molecular Medicine. Springer Science and Business Media LLC; 2020; 10.1038/s12276-020-00541-3
The apple dihydrochalcone phloretin suppresses growth and improves chemosensitivity of breast cancer cells via inhibition of cytoprotective autophagy
Chen M, Gowd V, Wang M, Chen F, Cheng K. The apple dihydrochalcone phloretin suppresses growth and improves chemosensitivity of breast cancer cells via inhibition of cytoprotective autophagy. Food & Function. Royal Society of Chemistry (RSC); 2020; 10.1039/d0fo02362k
Toxicity Reduction and Efficacy Promotion of Doxorubicin in the Treatment of Breast Tumors Assisted by Enhanced Oral Absorption of Curcumin-Loaded Lipid–Polyester Mixed Nanoparticles
Wang N, Zhang Y, Liu H, Wang A, Ren T, Gou J, et al. Toxicity Reduction and Efficacy Promotion of Doxorubicin in the Treatment of Breast Tumors Assisted by Enhanced Oral Absorption of Curcumin-Loaded Lipid–Polyester Mixed Nanoparticles. Molecular Pharmaceutics. American Chemical Society (ACS); 2020; 17:4533-4547 10.1021/acs.molpharmaceut.0c00718
Cellular Mechanisms Triggered by the Cotreatment of Resveratrol and Doxorubicin in Breast Cancer: A Translational In Vitro–In Silico Model
Vargas JE, Puga R, Lenz G, Trindade C, Filippi-Chiela E. Cellular Mechanisms Triggered by the Cotreatment of Resveratrol and Doxorubicin in Breast Cancer: A Translational In Vitro–In Silico Model. Oxidative Medicine and Cellular Longevity. Hindawi Limited; 2020; 2020:1-23 10.1155/2020/5432651
Combining naringenin and metformin with doxorubicin enhances anticancer activity against triple-negative breast cancer in vitro and in vivo
Pateliya B, Burade V, Goswami S. Combining naringenin and metformin with doxorubicin enhances anticancer activity against triple-negative breast cancer in vitro and in vivo. European Journal of Pharmacology. Elsevier BV; 2020; 891:173725 10.1016/j.ejphar.2020.173725
Doxorubicin and Crocin Co-delivery by Polymeric Nanoparticles for Enhanced Anticancer Potential In Vitro and In Vivo
Khan I, Joshi G, Sarkar B, Nakhate KT, Ajazuddin , Mantha AK, et al. Doxorubicin and Crocin Co-delivery by Polymeric Nanoparticles for Enhanced Anticancer Potential In Vitro and In Vivo. ACS Applied Bio Materials. American Chemical Society (ACS); 2020; 3:7789-7799 10.1021/acsabm.0c00974
Apigenin by targeting hnRNPA2 sensitizes triple-negative breast cancer spheroids to doxorubicin-induced apoptosis and regulates expression of ABCC4 and ABCG2 drug efflux transporters
Sudhakaran M, Parra MR, Stoub H, Gallo KA, Doseff AI. Apigenin by targeting hnRNPA2 sensitizes triple-negative breast cancer spheroids to doxorubicin-induced apoptosis and regulates expression of ABCC4 and ABCG2 drug efflux transporters. Biochemical Pharmacology. Elsevier BV; 2020; 182:114259 10.1016/j.bcp.2020.114259
Cardioprotective effect of grape polyphenol extract against doxorubicin induced cardiotoxicity
Sergazy S, Shulgau Z, Fedotovskikh G, Chulenbayeva L, Nurgozhina A, Nurgaziyev M, et al. Cardioprotective effect of grape polyphenol extract against doxorubicin induced cardiotoxicity. Scientific Reports. Springer Science and Business Media LLC; 2020; 10 10.1038/s41598-020-71827-9
Curcumin suppresses doxorubicin-induced cardiomyocyte pyroptosis via a PI3K/Akt/mTOR-dependent manner
Yu W, Qin X, Zhang Y, Qiu P, Wang L, Zha W, et al. Curcumin suppresses doxorubicin-induced cardiomyocyte pyroptosis via a PI3K/Akt/mTOR-dependent manner. Cardiovascular Diagnosis and Therapy. AME Publishing Company; 2020; 10:752-769 10.21037/cdt-19-707
Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial
Khodabakhshi A, Seyfried TN, Kalamian M, Beheshti M, Davoodi SH. Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial. Nutrition Journal. Springer Science and Business Media LLC; 2020; 19 10.1186/s12937-020-00596-y