title: Continuing routine cardiac surveillance in long-term use of pegylated liposomal doxorubicin: is it necessary?
abstract: OBJECTIVE
  The objective of this study was to determine the cardiac safety of high cumulative doses of pegylated liposomal doxorubicin (PLD) in patients with gynecologic malignancies and the need for routine evaluation of left ventricular ejection fraction (LVEF).
  
  
  METHODS
  Data were collected for all patients treated with PLD with at least one evaluation of LVEF with either Multi-Gated Acquisition (MUGA) scan or echocardiogram from January 2006 to May 2012. Evaluation of LVEF was used to detect PLD-related cardiac toxicity (defined as a decline in LVEF of greater than 10% compared to baseline measurements).
  
  
  RESULTS
  A total of 141 patients were included. Twenty-two patients were treated with a cumulative dose of 500 mg/m(2) or more, and five patients with 1000 mg/m(2) or more. Ten patients (7%) had a reduction in LVEF of greater than 10%, 38 had no significant change or increase in LVEF throughout the duration of treatment, and 93 did not require a follow-up evaluation of LVEF. The LVEFs of two patients dropped below 50% at cumulative doses of 1110 mg/m(2) and 1670 mg/m(2); one began with a baseline of 52%.
  
  
  CONCLUSIONS
  Only one patient had a clinically significant decrease in LVEF at a cumulative dose of 1670 mg/m(2), suggesting that PLD does not carry a significant risk of cardiotoxicity, as evidenced by the stability of LVEF even after treatment with large cumulative doses. Routine surveillance of LVEF does not seem to be necessary or cost effective in the absence of other risk factors.
authors.affiliation: Department of Obstetrics and Gynecology, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA. SGill2@ghs.org
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Gill
authors.forename: Kari
authors.initials: K
authors.lastname: Savage
authors.forename: Weiya Z
authors.initials: WZ
authors.lastname: Wysham
authors.forename: Dawn W
authors.initials: DW
authors.lastname: Blackhurst
authors.forename: William E
authors.initials: WE
authors.lastname: Winter
authors.forename: Larry E
authors.initials: LE
authors.lastname: Puls
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects*; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016903:Drug Monitoring; D004452:Echocardiography; D005260:Female; D015637:Gated Blood-Pool Imaging; D006321:Heart / Q000187:drug effects*; D006331:Heart Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D060046:Maintenance Chemotherapy; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000903:Antibiotics, Antineoplastic; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin