Platinum/
taxane regimens induce high response rates and prolong survival in women with
ovarian cancer. After recurrence, however, response to second-line
chemotherapy is limited.
Pegylated liposomal doxorubicin (
Doxil/
Caelyx [
PLD]), is the only liposomal
anthracycline indicated for second-line treatment of
platinum- and
paclitaxel-refractory
ovarian cancer. Response rates ranged from 14% to 20% in nonrandomized trials of this patient population. In a large phase 3 randomized trial, single-agent
PLD and
topotecan had similar efficacy overall in response rates, but
PLD-treated patients had significantly improved overall survival compared with
topotecan with a pronounced advantage in
platinum-sensitive patients. Another randomized trial reported that
PLD and
paclitaxel were comparable with regards to response rate, progression-free survival, and overall survival, regardless of the degree of
platinum sensitivity. Additional nonrandomized trials of
PLD in combination with other active agents resulted in response rates ranging from 20% to 76%.
PLD is generally well tolerated and its side-effect profile compares favorably with other commonly used chemotherapeutic agents in this clinical setting. Proper dosing and monitoring may further enhance tolerability while preserving the efficacy of this versatile agent for
ovarian cancer.