Efficacy and toxicity of nonpegylated liposomal doxorubicin in breast cancer

Anthracyclines, including doxorubicin, are the mainstay of therapy for breast cancer. However, doxorubicin can cause dose-dependent cardiotoxicity, limiting the cumulative dose. Liposomal conjugation of doxorubicin results in preferential distribution of doxorubicin in the tumor compared with normal tissues. Nonpegylated liposomal doxorubicin (NPLD) has demonstrated reduced cardiac toxicity, with anti-tumor responses comparable to those of conventional doxorubicin. The substitution of NPLD for conventional anthracyclines significantly reduces the cumulative cardiotoxicity, while allowing a higher cumulative dose. This allows patients who have already received the maximum cumulative dose of doxorubicin to receive further doxorubicin, as well as those with risk factors for anthracycline-induced cardiotoxicity. The favorable cardiac safety profile of NPLD may allow it to be combined with newer therapies, such as trastuzumab.