Anthracyclines are valuable cytotoxic agents in cancer treatment. However, their usefulness is limited by cumulative dose-dependent cardiotoxicity that may manifest as life-threatening congestive heart failure. To avoid cardiotoxicity, the use of doxorubicin is typically capped at a safe cumulative dose. Liposomal formulations may reduce cardiac risks whilst maintaining anti-cancer efficacy. Efficacy and safety studies of non-pegylated liposomal doxorubicin (NPLD) in metastatic breast cancer (MBC) are reviewed, along with studies that examine efficacy and cardiac tolerability in combination with newer agents such as paclitaxel and trastuzumab. These show that cardiac safety of liposomal doxorubicin is similar to that of epirubicin in cumulative dose, but that the formulation, unlike epirubicin, has similar anti-cancer efficacy to doxorubicin at equimolar doses. Liposomal doxorubicin may have a better therapeutic index than non-liposomal anthracyclines. This justifies further studies in patients where cumulative cardiotoxicity is a concern, as does study of its use with other potentially cardiotoxic agents.

Background Paclitaxel (PTX) and pegylated liposomal doxorubicin (PLD) are active cytotoxic agents for the treatment of human immunodeficiency (HIV) associated Kaposi’s sarcoma (KS). We performed a randomized trial comparing the efficacy and toxicity of PTX and PLD, and determine the effects of therapy on symptom palliation and quality of life. Methods Patients with advanced HIV-associated KS were randomly assigned to receive PTX (100 mg/m2) IV every 2 weeks, or PLD 20 mg/m2 IV every 3 weeks. The KS Functional Assessment of HIV (FAHI) Quality of Life instrument was used before and after every other treatment cycle. Results The study included 73 analyzable patients enrolled between 1998 and 2002, including 36 in the PTX arm and 37 in the PLD arm; 73% received highly active antiretroviral therapy (HAART) and 32% had undetectable viral load (<400 copies/mL). Treatment was associated with significant improvement in pain (P=0.024) and swelling (P<0.001). Of the 36 patients who reported that pain interfered with their normal work or activities at baseline, 25 (69%) improved. Of the 41 patients who reported swelling at baseline, 38 (93%) improved. Comparing the PTX and PLD arms revealed comparable response rates (56% vs. 46%; p=0.49), median progression free survival (17.5 vs. 12.2 months; p=0.66), and 2-year survival (79% vs. 78%; p=0.75), but somewhat more grade 3–5 toxicity for PTX (84% vs. 66%, p=0.077). Conclusion Treatment with either PTX or PLD produces significant improvement in pain and swelling in patients with advanced, symptomatic, HIV-associated KS treated in the early HAART era.

Liposomal daunorubicin at 100 mg/m2 every three weeks has activity in patients with relapsed or refractory NHL, including patients with prior exposure to an anthracycline. Further studies of liposomal daunorubicin in combination with other agents are warranted.

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PTCL-NOS (54%), five cases of angioimmunoblastic T-cell lymphoma (18%) and four cases of ALK-negative anaplastic large cell lymphoma (14%) among others. The median age of the patients was 59 years (range, 23-75 years). After treatments with BCD, which delivered a median of three BCD cycles, there were 8 patients with complete responses (CR; 30%) and seven with partial responses (PR; 25%). The overall response rate (RR) was 55%. Five patients preceded to ASCT, and three patients finally achieved CR. The median progression free survival was 4.8 months with a median follow-up duration of 4.5 months. In a total of 85 cycles of BCD, grade 3 or 4 neutropenia, thrombocytopenia and anemia occurred in 17.6%, 38.8% and 16.5% of cycles, respectively. Only one patient experienced febrile neutropenia. Conclusions: BCD is an effective salvage regimen for relapsed or refractory PTCLs and can be administered with acceptable toxicity. Introduction: Anthracycline-based chemotherapy is commonly used as the first line treatment for aggressive T-cell lymphoma. The aim of this study was to evaluate the efficacy and toxicity of pegylated liposomal doxorubicin (PLD) combined with cyclophosphamide, vincristine/ vindesine, and prednisone in patients with aggressive T-cell lymphoma. Methods: Patients with newly diagnosed aggressive T-cell lymphoma except for NK/T-cell lymphoma were eligible and treated with 6 cycles of PLD (40 mg/m 2 day 1), cyclophosphamide (750 mg/m 2 day 1), vin-cristine (1.4 mg/m 2 day 1) or vindesine (2 mg/m 2 day 1) and predni-sone (100 mg days 1-5). The primary endpoint was the overall response rate (ORR). Results: A total of 40 patients were enrolled, and 39 were evaluable for response assessment. The patient characteristics were shown in Table 1. The ORR was 84.6%, and 18 patients (46.2%) achieved the complete response (CR). The ORRs of patients with 3 major histology (PTCL nos, ALCL and AITL) were 72.2%, 90.9% and 100%, respectively. The common grade 3/4 toxicities included neutropenia (87.5%), anemia (17.5%), pneumonia (15%) and mucositis (7.5%). Although 7 patients (17.5%) developed hand-foot syndrome and only 1 was grade 3, no treatment-related mortality was observed. Conclusions: This PLD-containing regimen is effective and tolerable in patients with aggressive T-cell lymphoma. Longer follow-up time is needed for analyzing the survival results.