title: Multicenter experience of nonpegylated liposomal doxorubicin use in the management of metastatic breast cancer.
abstract: BACKGROUND
  This study aimed to investigate the use of nonpegylated liposomal doxorubicin (NPLD) in the management of metastatic breast cancer (MBC) within routine UK clinical practice and to assess its efficacy and tolerability.
  
  
  METHODS
  All patients that received NPLD for MBC at 5 institutions were identified. Clinicopathologic details, echocardiographic data, and toxicities were documented. Response to treatment, outcome, cardiotoxicity, and safety were assessed.
  
  
  RESULTS
  63 patients (median age at NPLD therapy, 53.5 years) who had received NPLD were identified; 18 (29%) were anthracycline-naïve, and 42 (67%) were anthracycline-pretreated (median cumulative dose of epirubicin, 450 mg/m(2)). In 3 cases, prior treatment history was not available. NPLD was most frequently (16 [25%] of 63 patients) administered as first-line chemotherapy (median, third-line; range, 1-9), although it was given later in anthracycline-pretreated patients (median, fourth-line; range, 1-9). Overall, 14 (29%) of 49 evaluable patients achieved an objective response, which increased to 10 (71%) of 14 when NPLD was given first-line (anthracycline-naïve, 8 [100%] of 8; anthracycline-pretreated, 2 [50%] of 4; adjuvant treatment unknown, 2). Median progression-free survival was 7 months (first-line, 18 months, vs. ≥ second-line, 6 months; P = .0066), and median overall survival was 10 months (first-line, 18 months, vs. ≥ second-line, 10 months; P = .0971). Toxicities tended to be grade 1 or 2. Three patients had cardiotoxicity (left ventricular ejection fraction < 50% or a fall of ≥ 10% from baseline), which resolved during treatment.
  
  
  CONCLUSIONS
  NPLD was used in both anthracycline-naïve patients and those with prior exposure. There is evidence of clinical activity in those with prior exposure to anthracyclines, with a low incidence of cardiotoxicity.
authors: Department of Medical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom; Liverpool and Merseyside Academic Unit, Cancer Services, Royal Liverpool University Hospital, Liverpool, United Kingdom; Academic Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom. Electronic address: c.palmieri@liverpool.ac.uk.
authors: Carlo
authors: C
authors: Palmieri
authors: The Christie NHS Foundation Trust, Manchester, United Kingdom.
authors: Vivek
authors: V
authors: Misra
authors: Department of Medical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors: Adam
authors: A
authors: Januszewski
authors: The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
authors: Hosney
authors: H
authors: Yosef
authors: Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom.
authors: Richard
authors: R
authors: Ashford
authors: Strategen Limited, Basingstoke, United Kingdom.
authors: Ian
authors: I
authors: Keary
authors: Helen Rollason Cancer Charity, Chelmsford, Essex, United Kingdom.
authors: Neville
authors: N
authors: Davidson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D004317:Doxorubicin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D009367:Neoplasm Staging; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000903:Antibiotics, Antineoplastic; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin
keywords: Advanced; Anthracycline; Cardiotoxicity; Chemotherapy; Rechallenge