TITLE:
Cardiac Safety with High Cumulative Dose of Pegylated Liposomal Doxorubicin in Patients with Metastatic Breast Cancer Previously Treated with Conventional Anthracyclines
AUTHORS:
Ahmed Refaat, Dalia O. Mohamed, Elsayed Mostafa Ali, Salah Mabrouk Khallaf
KEYWORDS:
Metastatic Breast Cancer, Pegylated Liposomal Doxorubicin, High Cumulative Dose, Cardiac Toxicity
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.9 No.3,
May
18,
2020
ABSTRACT: Introduction: The treatment of metastatic breast cancer (MBC) is still challenging. Many
studies documented the efficacy of pegylated
liposomal doxorubicin (PLD) in patients with MBC, but there is a limited data
about the cardiac safety with high cumulative dose (HCD) of PLD. Aim of the
work: We conducted this trial to outline the cardiac
safety of HCD of PLD in patients with
MBC who previously received conventional anthracyclines. Methods: During the period of nine years (January 2011 to
December 2019). We extracted the data of the patients with MBC receiving
PLD at Medical Oncology Department, South Egypt Cancer Institute, Assiut
University. These included patients’ demographics and therapeutic data
including the full data of PLD, prior conventional anthracyclines, prior
trastuzumab, and prior radiotherapy. Also, data about comorbidities as well as
cardiac and other toxicities of PLD were obtained. The data was analysed using
SPSS v. 21. Results: For all 81 eligible patients, the mean age was 43.9
years (±standard deviation (SD) 13.2). The mean cumulative dose of PLD was
378.4 mg/m2 (± SD of 250.2) and a range of 100 - 1200
mg/m2. About thirty-one (38.3%) patients received high cumulative dose (400 mg/m2 or more),
while the remaining 50 patients did not. The decline in left
ventricular ejection fraction (LVEF) was relatively rare; and of low grade. Grade 2 decline in LVEF occurred in only two patients who
received high cumulative dose of PLD, and only one patient who did not reach
HCD (p = 0.555). Grade 3 or 4 decline in LVEF did not occur in patients either with
or without HCD. Regarding other toxicities, there was a significant increase in
incidence of all grades palmar plantar erythrodysesthesia (PPE) in patients who received HCD of PLD when compared to those who did not reach the HCD (38.7% versus 16% respectively; p = 0.021). Conclusion: Our study concluded that the use of
PLD seems to be a justified agent in the treatment of MBC who previously
treated by conventional anthracyclines in the adjuvant, metastatic or both settings,
even in patients reaching the cumulative dose of conventional anthracycline.