title: Skin toxicity associated with pegylated liposomal doxorubicin (40 mg/m2) in the treatment of gynecologic cancers.
abstract: OBJECTIVE
  To characterize the incidence of skin toxicity of pegylated liposomal doxorubicin (PLD) administered at a lower dose (40 mg/m(2)) in the treatment of advanced gynecologic malignancies.
  
  
  METHODS
  Medical charts of all patients who initiated PLD at a starting dose of 40 mg/m(2) from 1997 to 2003 for the treatment of gynecologic cancers were retrospectively reviewed. PLD was infused over 1-2 h and administered every 4-6 weeks. No patient had previously received doxorubicin. All patients were clinically assessed for adverse reactions including skin toxicity.
  
  
  RESULTS
  Ninety patients (mean age 62 years, range 45-82 years) were included in this analysis. There were 55 ovarian, 16 endometrial, 2 fallopian, and 17 primary peritoneal cancers. The median cumulative dose of PLD was 120 mg/m(2) (range 40-855 mg/m(2)) with a median of 3 cycles (range 1-25). 33/90 (37%) developed a skin reaction during therapy. The overall incidence of grade 1, 2, and 3 skin toxicity was 23 (26%), 9 (10%), and 1 (1%), respectively. Of the 23 cases of grade 1 toxicity, 16 (70%) occurred within 1-3 cycles. All 9 cases of grade 2 toxicity occurred within 1-3 cycles. The only case of grade 3 toxicity occurred after the first cycle. 28/30 (93%) patients who continued treatment did not experience further episodes of skin toxicity with subsequent cycles after a dose reduction (5-20 mg/m(2)). PLD was stopped in only 2/90 (2%) cases due to a skin reaction.
  
  
  CONCLUSIONS
  Severe skin toxicity (> or =grade 2) associated with PLD occurs infrequently when initial doses of 40 mg/m(2) are administered. When skin reactions appear, they usually occur early in the course of treatment, respond to dose reduction, and do not appear to limit the duration of treatment.
authors.affiliation: Department of Gynecology/Obstetrics, Gynecologic Oncology Program, Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A81, Cleveland, OH 44195, USA. kimr@ccf.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Kim
authors.forename: Gertrude
authors.initials: G
authors.lastname: Peterson
authors.forename: Barbara
authors.initials: B
authors.lastname: Kulp
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Zanotti
authors.forename: Maurie
authors.initials: M
authors.lastname: Markman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000139:chemically induced*
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin