Pegylated liposomal doxorubicin does not affect cardiac function in patients treated for gynecologic malignancies

Although pegylated liposomal doxorubicin (PLD) has a more favorable side-effect profile compared to doxorubicin, the FDA label for PLD includes a warning listing cardiotoxicity. Our objective was to evaluate predictors of pre- and post-treatment cardiac testing and quantify the effect of PLD on cardiac function in patients treated for gynecologic malignancies.

Retrospective chart review of gynecologic oncology patients who received PLD over a 10-year period at a single institution. Cardiac studies were aligned to PLD treatment and ejection fractions (EF) were compared pre- and post-treatment.

A total of 453 patients who had received PLD were identified; 216 (48 %) had pre-PLD treatment cardiac function testing. Predictors of pre-chemotherapy testing were diabetes (p = 0.015), higher ECOG score (p = 0.004), and cardiac disease (p = 0.032). Eighty-three (18.3 %) patients had pre- and post-PLD treatment cardiac function testing. Predictors of pre- and post- testing were number of cycles of PLD (p < 0.0001) and total dose of PLD (p < 0.0001). Seventy-five (90 %) patients had no change in EF (defined as < 10 %), while 2 (2.4 %) had improvement in EF > 10 %, and 6 (7.2 %) had a decrease in EF > 10 %. Initial EF in patients with > 10 % decrease was higher than in those without change or improvement (p = 0.0004). One (1.2 %) patient had a clinically significant decrease in EF (32.5 %) resulting in interruption of treatment.

Risk of cardiac toxicity from administration of PLD for patients undergoing treatment for gynecologic cancers appears to be low. Selective screening of cardiac function should be employed for these patients.