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Cardiac Safety with High Cumulative Dose of Pegylated Liposomal Doxorubicin in Patients with Metastatic Breast Cancer Previously Treated with Conventional Anthracyclines

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.