Continuing routine cardiac surveillance in long-term use of pegylated liposomal doxorubicin: Is it necessary?

Gill, Sarah; Savage, K.; Wysham, Weiya Z.; Blackhurst, Dawn W.; Winter, William E.

doi:10.1016/j.ygyno.2013.03.012

Cited by 30 publications

(19 citation statements)

References 18 publications

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“…Despite relatively large cumulative doses of PLD and prolonged use, none of the patients experienced cardio-toxic side-effects as seen with doxorubicin, and our data seem to support that routine cardiac surveillance is not necessary with PLD (9). Therefore, in this group of patients, all of the major goals of treatment for recurrent ovarian cancer were achieved: prolongation of progressionfree interval and improvement in performance status, coupled with manageable toxicities.…”

Section: Discussionsupporting

confidence: 51%

“…Therefore, in this group of patients, all of the major goals of treatment for recurrent ovarian cancer were achieved: prolongation of progressionfree interval and improvement in performance status, coupled with manageable toxicities. Despite relatively large cumulative doses of PLD and prolonged use, none of the patients experienced cardio-toxic side-effects as seen with doxorubicin, and our data seem to support that routine cardiac surveillance is not necessary with PLD (9). The BRCA status of the patients is incomplete and does not allow its influence on response to prolonged PLD treatment to be evaluated (10).…”

Section: Discussionmentioning

confidence: 59%

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Prolonged pegylated liposomal doxorubicin treatment for recurrent pelvic cancers: a feasibility study

Rabinovich

Ramanakumar

Gotlieb

2015

Acta Obstet Gynecol Scand

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We conducted a proof of concept study evaluating prolonged treatment with pegylated liposomal doxorubicin for recurrent ovarian, tubal and peritoneal carcinoma. Thirteen consecutive patients received an average of 22.6 cycles of pegylated liposomal doxorubicin, with an average cumulative dose of 1409 mg/m(2) . Progression-free survival at 18 months was 61.5%, and was longer than the previous progression-free survival in 10 of the 13 patients. Overall 5-year survival was 78.8%. Despite prolonged use and relatively large cumulative doses of pegylated liposomal doxorubicin, most of the patients had mild to moderate side-effects, none of the patients had detectable cardio-toxic side-effects, and a positive impact on the performance status was noticed. Thus, in our group of patients, continued pegylated liposomal doxorubicin treatment was associated with a longer progression-free interval and allowed improved performance status with manageable toxicity.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 59%

Prolonged pegylated liposomal doxorubicin treatment for recurrent pelvic cancers: a feasibility study

Rabinovich

Ramanakumar

Gotlieb

2015

Acta Obstet Gynecol Scand

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“…Anthracyclines are widely used antineoplastic agents for the treatment of both childhood hematological malignancies and solid tumors, including acute lymphoblastic leukemia (ALL), acute myeloid leukemia, non-Hodgkin and Hodgkin's lymphoma, neuroblastoma, osteosarcoma, Ewing tumors, and nephroblastoma. Almost 60% of children with cancer receive anthracyclines as a part of their treatment [ 1 ]. A major limitation of anthracycline is the risk of cardiotoxicity, manifested as asymptomatic cardiac dysfunction in up to 57% [ 2 , 3 ] and cardiomyopathy with subsequent clinical heart failure in up to 16% [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

NT-proBNP as Early Marker of Subclinical Late Cardiotoxicity after Doxorubicin Therapy and Mediastinal Irradiation in Childhood Cancer Survivors

et al. 2015

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Background. Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity. Aims of the Study. To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation. Methods. A cross-sectional study on 58 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols and 32 asymptomatic Hodgkin's lymphoma survivors who received anthracycline and mediastinal irradiation. Levels of NT-proBNP, TDI, and conventional echocardiography were determined. Results. Thirty percent of survivors had abnormal NT-proBNP levels. It was significantly related to age at diagnosis, duration of follow-up, and cumulative dose of doxorubicin. TDI detected myocardial affection in 20% more than conventional echocardiography. Furthermore, abnormalities in TDI and NT-pro-BNP levels were more common in Hodgkin lymphoma survivors receiving both chemotherapy and radiotherapy. Conclusions. TDI could detect early cardiac dysfunction even in those with normal conventional echocardiography. Measurement of NT-proBNP represents an interesting strategy for detecting subclinical cardiotoxicity. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity.

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“…PLD is suspected to have the advantage of low cardiac toxicity. After following 141 patients, Gill et al reported that only one patient had a clinically significant decrease in LVEF at a cumulative dose of 1670 mg/m 2 , suggesting that this routine surveillance of LVEF may not be necessary in the absence of other risk factors [ 24 ]. Similarly, the current study found that there was no significant decline in LVEF after treatment, including patients who had a history of cardiovascular disease or who were treated with anthracycline prior to the study.…”

Section: Discussionmentioning

confidence: 99%

Pegylated liposomal doxorubicin (Lipo-Dox®) combined with cyclophosphamide and 5-fluorouracil is effective and safe as salvage chemotherapy in taxane-treated metastatic breast cancer: an open-label, multi-center, non-comparative phase II study

et al. 2015

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BackgroundAnthracycline and taxane are classes of drugs that are frequently used in the adjuvant and palliative settings of metastatic breast cancer (MBC); however, treatment failure occurs in most cases. Limited data demonstrated favorable response in MBC after previous taxane-based treatment. The aim of this study was to evaluate the efficacy and safety of pegylated liposomal doxorubicin (Lipo-Dox®) used as part of a combination salvage therapy for patients with MBC whose tumors progressed during or after taxane-based treatment.MethodsPatients with MBC who failed to respond to previous taxane-based treatments were recruited. Treatment with pegylated liposomal doxorubicin (40 mg/m2), cyclophosphamide (500 mg/m2), and 5-fluorouracil (500 mg/m2) was administered every 3 weeks. Tumor response to treatment was determined by using the Response Evaluation Criteria in Solid Tumor criteria version 1.0, and left ventricular ejection fraction was measured before and after treatment using echocardiography. Each patient was followed for 30 days after the last dose of study medication or until resolution/stabilization of any drug-related adverse event.ResultsForty-five patients were recruited. As of December 2012, the median follow-up duration was 29.8 months, the overall response rate was 41.9 %, the median progression-free survival was 8.2 months, and the median overall survival was 36.6 months for all treated patients. Grade 3/4 neutropenia, leucopenia, and neutropenic fever were observed in 14 %, 9 %, and 1 % of the cycles, respectively. Other non-hematologic adverse effects were mild to moderate and were manageable. No decrease in left ventricular ejection function was noted.ConclusionThis regimen of combined of pegylated liposomal doxorubicin, cyclophosphamide, and 5-fluorouracil exhibited a promising overall response rate, progression-free survival rate, and overall survival rate, with a safe cardiac toxicity profile and manageable adverse effects. This regimen could be considered as a treatment option for patients with MBC whose tumors progressed during or after taxane-based treatment.

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Continuing routine cardiac surveillance in long-term use of pegylated liposomal doxorubicin: Is it necessary?

Cited by 30 publications

References 18 publications

Prolonged pegylated liposomal doxorubicin treatment for recurrent pelvic cancers: a feasibility study

Prolonged pegylated liposomal doxorubicin treatment for recurrent pelvic cancers: a feasibility study

NT-proBNP as Early Marker of Subclinical Late Cardiotoxicity after Doxorubicin Therapy and Mediastinal Irradiation in Childhood Cancer Survivors

Pegylated liposomal doxorubicin (Lipo-Dox®) combined with cyclophosphamide and 5-fluorouracil is effective and safe as salvage chemotherapy in taxane-treated metastatic breast cancer: an open-label, multi-center, non-comparative phase II study

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