Efficacy and Cardiotoxicity of Liposomal Doxorubicin-Based Chemotherapy in Advanced Breast Cancer: A Meta-Analysis of Ten Randomized Controlled Trials

BACKGROUND Various trials have compared the efficacy and toxicity of liposomal doxorubicin-based chemotherapy with the conventional formulation of doxorubicin although arriving at inconsistent conclusions. To derive a conclusive assessment of the efficacy and cardiotoxicity associated with chemotherapy, we performed a meta-analysis by combining data from all eligible randomized controlled trials. METHODS We used the PubMed database to identify relevant studies published through December 28, 2014. Eligible studies included randomized controlled trials directly comparing the efficacy and cardiotoxicity of liposomal doxorubicin-based chemotherapy with conventional doxorubicin in advanced breast cancer with adequate data. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the efficacy and cardiotoxicity in a fixed-effects or random-effects model. RESULTS Ten randomized controlled trials containing efficacy and data from a total of 2,889 advanced breast cancer patients were included in this report. Liposomal doxorubicin-based chemotherapy was associated with a significant reduction in the risk of cardiotoxicity (OR = 0.46, 95% CI 0.23 to 0.92, p = 0.03) and a significant improvement in the overall response rate (ORR) (OR = 1.25, 95% CI 1.02 to 1.52, p=0.03) compared with conventional doxorubicin. An apparent improvement in progression-free survival (PFS) for patients treated with liposomal doxorubicin-based chemotherapy was noted; however, this difference was not significant (HR = 1.14, 95% CI 0.96 to 1.34, p = 0.12). In terms of overall survival (OS), no significant difference between the two chemotherapy regimens was noted (HR = 1.00, 95% CI 0.91 to 1.10, p = 0.93). CONCLUSION The results of this meta-analysis suggest that liposomal doxorubicin-based chemotherapy is associated with a significant improvement in the ORR and a significant reduction in the risk of cardiotoxicity.