The need for effective, well-tolerated, and convenient
therapies for patients with advanced
ovarian cancer has led researchers to continually refine chemotherapeutic regimens to balance efficacy with safety and tolerability in order to maintain or improve patient quality of life. In this article, we review current strategies for the optimal dosing of
pegylated liposomal doxorubicin (
DOXIL; Tibotec
Therapeutics, a division of Ortho Biotech Products, L.P., Bridgewater, NJ, http://www.tibotec.com;
Caelyx, Schering-Plough Corporation, Kenilworth, NJ, http://www.sch-plough.com) in relapsed
ovarian cancer.
Pegylated liposomal doxorubicin has demonstrated efficacy in the treatment of recurrent/resistant
ovarian cancer in several clinical trials utilizing a dose of 50 mg/m2 every 4 weeks. The most common adverse events associated with
pegylated liposomal doxorubicin treatment in these studies-
hand-foot syndrome (HFS, also known as palmar-plantar erythrodysesthesia) and
stomatitis-are schedule and dose dependent, respectively, and do not typically lead to discontinuation of
therapy. Several phase II and retrospective studies support the use of
pegylated liposomal doxorubicin 40 mg/m2 every 4 weeks (dose intensity of 10 mg/m2 weekly) to optimize clinical efficacy and minimize the occurrence of schedule- and dose-related adverse events in patients with recurrent/relapsed
ovarian cancer. Further reductions in dose intensity are necessary for use in combined
chemotherapy regimens. Antitumor activity was maintained, with reduced incidences of HFS and
stomatitis. Given the chronic course of
ovarian cancer, the improved tolerability profile of
pegylated liposomal doxorubicin 40 mg/m2 combined with a convenient once-monthly dosing schedule may translate into an improved quality of life for patients with
ovarian cancer.