I remember the very first day I ever stepped on the floor as a medical student. I was nervous and my coat was weighed down with my ‘external brain’, which included a palm pilot loaded with Epocrates – a program to look up drug dosing, side effects etc., Maxwell’s guide to teach me how to write a note, and some big blue bulky internal medicine pocket reference thing. By the end of the day, my neck was sore from the weight of my short white coat and I had spent 20 (maybe more) minutes that first day trying to figure out if a calcium value of 8.8 was normal (it is).
Fast forward 5 years and those things were like second nature, but then came the alphabet soup of chemotherapy. VAdriaC, VDC, VAC, IE, VP16, IE, VIT, Topo/Cyclo. Say what? For the longest time I couldn’t figure out why or how VDC was the exact same regimen as VAdriaC. The answer is history.
D = doxorubicin = Adriamycin (Adria). Makes total sense right? Doxorubicin is a chemotherapy drug that was discovered in the 1950s as a derivative of daunorubicin. Bonus fun fact: daunorubicin was discovered from a soil bacteria, Streptomyces peucetius, that made a red pigmented antibiotic that turned out to be effective against mouse tumors. Dauni is the name of the Roman tribe that used to occupy the area where it was found and rubis is the French word for red. Anyway Italian researchers mutated the bacteria to make a new drug they called Adriamycin after the Adriatic Sea (the sea that separates the Italian peninsula from the Balken peninsula).
The name was was later changed to doxorubicin (although the brand name was Adriamycin) to conform to naming conventions. Regardless, people will still refer to it as Adriamycin today.
Note even though daunorubicin and doxorubicin are technically antitumor antibiotics, they are never used for antibacterial therapy because they clearly have very strong side effects. So much so, that doxorubicin has gotten the infamous nickname of the Red Devil by patients, but more on that tomorrow.
