Annals of Oncology Advance Access originally published online on April 6, 2006
Annals of Oncology 2006 17(6):957-961; doi:10.1093/annonc/mdl079
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© 2006 European Society for Medical Oncology
Biweekly pegylated liposomal doxorubicin in patients with relapsed ovarian cancer: results of a multicenter phase-II trial
1 Department of Gynecology and Obstetrics, Charité University Medical Center, Berlin; 2 Center for Clinical Research, Unfallkrankenhaus Berlin; 3 Private Practice, Berlin; 4 Private Practice, Berlin; 5 Private Practice, Fürstenwalde; 6 Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, University of Munich; 7 Department of Gynecology and Obstetrics, St. Josef Krankenhaus GmbH Moers; 8 Department of Gynecology and Obstetrics, Friedrich-Schiller-University of Jena, Germany
* Correspondence to: Dr J. Sehouli, Department of Gynecology and Obstetrics, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 30 45056 4142; Fax: +49 30 45056 4904; E-mail: sehouli{at}aol.com
Background: The obvious benefit of pegylated liposomal doxorubicin (PLD) for tumour control in recurrent ovarian cancer is frequently offset by severe palmar-plantar erythrodysesthesia (PPE). There is evidence that dose reduction from 50 to 40 mg/m2 reduces the incidence of PPE without compromising cytotoxic activity. We set out to investigate whether biweekly application further improves the therapeutic index of PLD.
Patients and methods: Patients with recurrent ovarian cancer after surgery and adjuvant chemotherapy with platinum and taxane compounds were eligible to participate in this multi-institutional phase II study. PLD was administered at a dose of 20 mg/m2 every two weeks. Eligible patients had ECOG performance status of 
2, and sufficient organ function. We employed an optimized two-stage design to test the hypothesis that biweekly application of PLD reduces the frequency of grade III and IV PPE from 25% to 10%. Response and survival were addressed descriptively.
Results: Between October 2001 and February 2004, 64 patients with median age of 59 (range 38–81) years were recruited onto this trial. We evaluated 553 (median 7, range 1–25) courses of PLD treatment. Most patients were in their third or fourth line of chemotherapy. PPE was noted in 30 patients (47.6%), but only three participants progressed to grade 3 severity (4.7%, 95% confidence interval 1.0–13.1%). Partial response, stable disease, and tumour progression were observed in 5, 13, and 24 patients, respectively. Median overall and progression-free survival were 18.2 (range, 1.4–34.0) and 4.3 (range 0.5–22.3) months.
Conclusions: Biweekly PLD may reduce the incidence of PPE while retaining efficacy in relapsed ovarian cancer. Our data support the need for a randomized trial to strengthen these assumptions.
Key words: ovarian cancer, pegylated liposomal doxorubicin, biweekly schedule, toxic skin reactions, palmar-plantar erythrodysesthesia
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