Does liposomal doxorubicin improve heart side effects in lymphoma patients compared to conventional doxorubicin?

This study investigated the impact of liposomal doxorubicin (Adriamycin) on cardiac side effects in lymphoma patients compared to conventional doxorubicin. The study suggested that liposomal doxorubicin can reduce cardiac effects and still be an effective therapy, particularly for patients at high risk for anthracycline-induced cardiotoxicity (AIC).

Anthracyclines (ACs) like doxorubicin play a major role in modern cancer treatment, including elderly lymphoma patients. Unfortunately, this therapy is associated with toxic cardiac (heart) side effects (AC-induced cardiotoxicity, or AIC). How often AIC occurs for NHL or HL patients after chemotherapy is unknown outside of clinical trials. New strategies are needed to better manage AIC.

Liposomal doxorubicin (NPLD) has been shown to have improved delivery to tumors in other cancers, but its effects have not been explored in lymphomas. Lymphoma patients at risk of cardiovascular diseases may benefit from NPLD instead of conventional doxorubicin, especially combined with ACE inhibitors or beta blockers.

This study involved 99 patients with various subtypes of NHL (75%; diffuse large b-cell lymphoma, mantle cell lymphoma, follicular lymphoma, or T-cell lymphoma) or HL (25%). 57% of patients had cardiac risk factors. 25% of these patients were taking medication (RAS or beta blockers). 39 patients received chemotherapy with liposomal doxorubicin (NPLD) instead of doxorubicin (DOX). 60 patients received chemotherapy with doxorubicin. Chemotherapies included ABVD or CHOP-like regimens (R-CHOP21, R-CHOP14). Patients were followed for 31.7 months.

79% of patients showed complete remission (tumor disappearance). 31.5% of these patients received NPLD. 14% of patients showed a partial response (tumor shrinkage), with 38.4% receiving NPLD. At 3 years, overall survival rates (time from treatment until death from any cause) were 94.7% for the DOX group, and 71.0% for the NPLD group. 

9% of patients had decreased blood pumping out of the left ventricle of the heart (LVEF between 10% and 50%). Of these, 8% received DOX and 1% received NPLD. 2.4% of this DOX group were treated with ACE inhibitors or beta blockers, completely reversing poor LVEF. Overall, the NPLD group showed better ventricle function and lower troponin I levels (marker of heart attack) compared to the DOX group.

This study suggested that substituting doxorubicin with liposomal doxorubicin in chemotherapy regimens for lymphoma patients at high cardiovascular risk can help prevent side effects without reducing effectiveness.

The current study has a small sample size (99 patients), and several lymphoma subtypes were included. This makes it difficult to accurately compare the efficacy of liposomal doxorubicin to the conventional doxorubicin.

If you are a lymphoma patient at high risk for anthracycline-induced cardiotoxicity (AIC), talk to your care team about using liposomal doxorubicin (NPLD) instead of conventional doxorubicin.