According to a review recently published in Gynecologic Oncology, Doxil® (pegylated liposomal doxorubicin) is the first choice for non-platinum-based chemotherapy for relapsed ovarian cancer.
Ovarian cancer is a malignancy that arises from various different cells located within the ovaries. Ovarian cancer accounts for 4% of cancers among women and is the fifth leading cause of cancer related deaths. Unfortunately, most ovarian cancers are not detected until the disease has progressed into the upper abdomen or other sites in the body. Currently, treatment consists of surgery, chemotherapy and sometimes radiation. First-line treatment of ovarian cancer often involves platinum-based chemotherapy drugs. However, if the cancer recurs after the initial treatment with platinum chemotherapy, other chemotherapeutic drugs may be used.
Doxorubicin is a chemotherapy drug that has been used for many years to treat ovarian cancer, as well as many other types of cancers. Doxil® consists of fat bubbles (liposomes) that contain doxorubicin, as well as an additional protective layer of glycol strands that protect the liposomes. When doxorubicin is administered, normal cells as well as cancer cells are affected and then the body quickly excretes it. Doxil® is designed to stay in the blood much longer due to the protective mechanisms of the drug’s design. This extended activity allows for increased exposure of the cancer cells to the chemotherapy. In addition, because Doxil® is slowly released over time, treatments are needed less frequently than with doxorubicin. Doxil® may also have less heart toxicity, which is the major dose-limiting toxicity of doxorubicin.
Authors of the study reviewed the need for safe and effective treatments for relapsed ovarian cancer that also improve the patient’s symptoms, enhance quality of life and prolong survival. A roundtable meeting was conducted in which experts in the management of ovarian cancer met to develop a consensus regarding the future role of Doxil® in ovarian and other gynecological malignancies. Previous research studies were reviewed which compared Doxil® to other common treatment agents. Several advantages were noted in patients treated with Doxil®, such as fewer dose modifications, less frequent treatment for low blood counts and a lower total cost per patient. In addition, Doxil® seemed to produce a survival advantage among patients with cancer that was sensitive to platinum chemotherapy. Other studies, which evaluated cardiac toxicity, were also reviewed and found that Doxil® improved cardiac safety when compared to other drugs within the same class.
Based on the survival and side effect advantages and the once monthly dosing schedule, Doxil® is the first choice for non-platinum chemotherapy for relapsed ovarian cancer. Further options may include using Doxil® as part of a combination of chemotherapy regimen for treating platinum-sensitive ovarian cancer or for maintenance therapy for first-line ovarian cancer or other gynecological cancers. Future clinical trials will further determine the role of Doxil® in other gynecological malignancies.
Reference: Thigpen J, Aghajanian C, Alberts D. et al. Role of Pegylated Liposomal Doxorubicin in Ovarian Cancer. Gynecologic Oncology. 2005; 96:10-18.