Levytska Khrystyna, Naumann R Wendel, Benfield Miranda J, Brown Jubilee, Casablanca Yovanni, Lees Brittany, Puechl Allison M, Crane Erin K
Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
Gynecol Oncol Rep. 2025 Mar 17;58:101727. doi: 10.1016/j.gore.2025.101727. eCollection 2025 Apr.
Although pegylated liposomal doxorubicin (PLD) has a more favorable side-effect profile compared to doxorubicin, the FDA label for PLD includes a warning listing cardiotoxicity. Our objective was to evaluate predictors of pre- and post-treatment cardiac testing and quantify the effect of PLD on cardiac function in patients treated for gynecologic malignancies.
Retrospective chart review of gynecologic oncology patients who received PLD over a 10-year period at a single institution. Cardiac studies were aligned to PLD treatment and ejection fractions (EF) were compared pre- and post-treatment.
A total of 453 patients who had received PLD were identified; 216 (48 %) had pre-PLD treatment cardiac function testing. Predictors of pre-chemotherapy testing were diabetes (p = 0.015), higher ECOG score (p = 0.004), and cardiac disease (p = 0.032). Eighty-three (18.3 %) patients had pre- and post-PLD treatment cardiac function testing. Predictors of pre- and post- testing were number of cycles of PLD (p < 0.0001) and total dose of PLD (p < 0.0001). Seventy-five (90 %) patients had no change in EF (defined as < 10 %), while 2 (2.4 %) had improvement in EF > 10 %, and 6 (7.2 %) had a decrease in EF > 10 %. Initial EF in patients with > 10 % decrease was higher than in those without change or improvement (p = 0.0004). One (1.2 %) patient had a clinically significant decrease in EF (32.5 %) resulting in interruption of treatment.
Risk of cardiac toxicity from administration of PLD for patients undergoing treatment for gynecologic cancers appears to be low. Selective screening of cardiac function should be employed for these patients.
尽管聚乙二醇化脂质体阿霉素（PLD）与阿霉素相比具有更有利的副作用特征，但PLD的美国食品药品监督管理局（FDA）标签包含心脏毒性的警示。我们的目的是评估治疗前和治疗后心脏检查的预测因素，并量化PLD对接受妇科恶性肿瘤治疗患者心脏功能的影响。
对在单一机构接受了10年PLD治疗的妇科肿瘤患者进行回顾性病历审查。将心脏研究与PLD治疗进行比对，并比较治疗前后的射血分数（EF）。
共确定了453例接受过PLD治疗的患者；216例（48%）在接受PLD治疗前进行了心脏功能测试。化疗前检查的预测因素为糖尿病（p = 0.015）、较高的东部肿瘤协作组（ECOG）评分（p = 0.004）和心脏病（p = 0.032）。83例（18.3%）患者在接受PLD治疗前后进行了心脏功能测试。治疗前后检查的预测因素为PLD的疗程数（p < 0.0001）和PLD的总剂量（p < 0.0001）。75例（90%）患者的EF无变化（定义为< 10%），而2例（2.4%）患者的EF改善> 10%，6例（7.2%）患者的EF下降> 10%。EF下降> 10%的患者的初始EF高于无变化或改善的患者（p = 0.0004）。1例（1.2%）患者的EF出现临床显著下降（32.5%），导致治疗中断。
接受妇科癌症治疗的患者因使用PLD而发生心脏毒性的风险似乎较低。应对这些患者采用选择性心脏功能筛查。
