Andreopoulou E, Gaiotti D, Kim E, Downey A, Mirchandani D, Hamilton A, Jacobs Allan, Curtin John, Muggia F
Division of Medical Oncology, Department of Medicine, New York University School of Medicine, NYU Cancer Institute, New York, NY 10016, USA.
Ann Oncol. 2007 Apr;18(4):716-21. doi: 10.1093/annonc/mdl484. Epub 2007 Feb 13.
We hypothesized that a response to pegylated liposomal doxorubicin (PLD, Caelyx/Doxil) followed by maintenance is beneficial and safe in recurrent ovarian cancer.
Sixteen patients have received PLD for more than 1 year for recurrent ovarian (14) or fallopian tube (2) cancer. All had stable disease or better responses to PLD + carboplatin (5) or topotecan (9) doublets or to PLD alone (2). PLD maintenance therapy 30-40 mg/m(2) was given every 4-8 weeks. This analysis focuses on cardiac status, overall tolerance, and time to recurrence.
Termination of PLD was due to progression in all patients. Noteworthy was the lack of cumulative myelosuppression and, with one exception, clinical cardiac toxicity. This patient was hospitalized with cardiogenic shock and fever complicating grade 4 pancytopenia from topotecan ten months after discontinuation of PLD. Seven patients continue to receive PLD after a median of 1680 mg/m(2) (1180-2460 mg/m(2)). Four of these had documented relapses after 3-6 years on maintenance occurring in the setting of lengthening of the treatment interval. Maintenance PLD was reinstituted after 'reinduction' with a platinum.
PLD appears to be safe as long-term maintenance in ovarian cancer and may be important for a continued response.
我们假设对于复发性卵巢癌，接受聚乙二醇化脂质体阿霉素（PLD，凯素/多柔比星脂质体）治疗后进行维持治疗是有益且安全的。
16例患者因复发性卵巢癌（14例）或输卵管癌（2例）接受PLD治疗超过1年。所有患者对PLD联合卡铂（5例）或拓扑替康（9例）双联方案或单独使用PLD（2例）均有疾病稳定或更好的反应。每4 - 8周给予30 - 40mg/m²的PLD维持治疗。本分析聚焦于心脏状况、总体耐受性和复发时间。
所有患者PLD治疗均因疾病进展而终止。值得注意的是，未出现累积性骨髓抑制，除1例患者外，也无临床心脏毒性。该患者在停用PLD十个月后因拓扑替康导致的4级全血细胞减少并发心源性休克和发热而住院。7例患者在接受中位剂量1680mg/m²（1180 - 2460mg/m²）的PLD治疗后仍继续接受治疗。其中4例在维持治疗3 - 6年后出现复发，此时治疗间隔延长。在使用铂类药物“再诱导”后重新开始维持性PLD治疗。
PLD作为卵巢癌的长期维持治疗似乎是安全的，且对于持续缓解可能很重要。
