Cardio-oncology (London, England) · 2025
Efficacy and cardiovascular safety of liposomal doxorubicin: a systematic review and meta-analysis of randomized trials.
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Cavalli Germano Dallegrave, Lopez-Lopez Jose P, Carandang Frances Caringal, Johnstone Ainsley, Scampoli Sara, Rana Ruqqiyah, Meireles Pedro Teixeira, Petropoulos Jo-Anne, Hillis Christopher, Balitsky Amaris, Upshaw Jenica, Leong Darryl P
Аннотация
BACKGROUND: Anthracyclines can cause dose-dependent cardiotoxicity that may be irreversible. To minimize cardiotoxic effects, substituting doxorubicin for liposomal doxorubicin (LD) has been explored as a cardioprotective strategy.
OBJECTIVES: To describe randomized clinical trials (RCTs) comparing the efficacy and safety of LD with other anthracycline-based regimens.
METHODS: We conducted a systematic review and meta-analysis of RCTs comparing LD with other anthracycline-based regimens, using data from Medline, Embase, Emcare, the Cochrane Central Register, and LILACS.
RESULTS: Twelve studies including 3027 patients with breast cancer (6), multiple myeloma (2), lymphoma (2), sarcoma (1), and acute lymphocytic leukemia (1) were included. Most participants (86%) were women with breast cancer. Nine studies compared LD with conventional doxorubicin and three with epirubicin. Overall, the risk of bias was classified as "some concerns". Follow-up ranged from 24-72 months - the median follow-up time among the studies was 37 months. There was a reduction in heart failure (HF) incidence in the LD group compared to the control (RR 0.32, 95%CI 0.18-0.55). A significant decrease in left ventricular ejection fraction (LVEF), as defined by each study´s criteria, was less frequent in the LD group compared to other anthracycline-based therapies (RR 0.39, 95%CI 0.30-0.51). All-cause mortality (RR 0.98, 95%CI 0.90-1.07) and tumor response (RR 0.99, 95%CI 0.93-1.05) did not differ between the groups.
CONCLUSIONS: LD use was associated with a decrease in the occurrence of HF compared to other anthracycline-based therapies, with no worse cancer outcomes. A significant decrease in LVEF was also less frequent in the LD group; however, no difference was found in cardiovascular mortality.
OBJECTIVES: To describe randomized clinical trials (RCTs) comparing the efficacy and safety of LD with other anthracycline-based regimens.
METHODS: We conducted a systematic review and meta-analysis of RCTs comparing LD with other anthracycline-based regimens, using data from Medline, Embase, Emcare, the Cochrane Central Register, and LILACS.
RESULTS: Twelve studies including 3027 patients with breast cancer (6), multiple myeloma (2), lymphoma (2), sarcoma (1), and acute lymphocytic leukemia (1) were included. Most participants (86%) were women with breast cancer. Nine studies compared LD with conventional doxorubicin and three with epirubicin. Overall, the risk of bias was classified as "some concerns". Follow-up ranged from 24-72 months - the median follow-up time among the studies was 37 months. There was a reduction in heart failure (HF) incidence in the LD group compared to the control (RR 0.32, 95%CI 0.18-0.55). A significant decrease in left ventricular ejection fraction (LVEF), as defined by each study´s criteria, was less frequent in the LD group compared to other anthracycline-based therapies (RR 0.39, 95%CI 0.30-0.51). All-cause mortality (RR 0.98, 95%CI 0.90-1.07) and tumor response (RR 0.99, 95%CI 0.93-1.05) did not differ between the groups.
CONCLUSIONS: LD use was associated with a decrease in the occurrence of HF compared to other anthracycline-based therapies, with no worse cancer outcomes. A significant decrease in LVEF was also less frequent in the LD group; however, no difference was found in cardiovascular mortality.