Predictive and Prognostic Factors for the Outcome of the Patients Receiving Pegylated Liposomal Doxorubicin for Advanced Breast Cancer

Purpose: The treatment of advanced breast cancer (ABC) is still challenging aiming mainly to improve or maintain the quality of life. The efficacy of pegylated liposomal doxorubicin (PLD) was proven in patients with ABC. Because its expensive treatment there is a great need to find the predictive factors for the clinical outcome of PLD. Our purpose was to evaluate the factors which would affect the clinical outcomes in patients receiving PLD for advanced breast cancer. Methods: Retrospectively, we studied the medical records of 60 eligible patients during the period of seven years (Jan. 2011-Dec. 2017). All patients were treated in Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt. We included only patients with visceral metastasis who received at least 2 cycles of PLD and had radiological assessment after that. Clinical benefit rate of PLD and survival outcome were assessed and correlated with patients and disease characteristic. Results: The majority of patients had a performance status grade II (81.7%), recurrent disease (86.7%), more than one metastatic site (83.3%), and chemoresistance to previous anthracycline (75%). The clinical benefit rate (CBR) to PDL was 30%. We found statistical significant association between higher CBR and biological subtypes (p < 0.001), type of metastatic breast disease (p = 0.003), chemosensitivity to anthracycline (p < 0.001), and the number of previous lines of chemotherapy (p = 0.041). The median progression-free survival (PFS) was five months. There was a statistically-significant improvement of PFS among patients with anthracycline-sensitive tumors compared to those with anthracycline-resistant tumors (10 months vs. 5 months, respectively, p = 0.004). The most common toxicity was palmar-plantar erythrodysesthesia (28% for all grade and 9% for grade 3 or more). There was no severe cardiotoxicity or treatment-related death. Conclusion: Pegylated liposomal doxorubicin appears to be more effective in patients with (luminal B with Her2neu positive, triple-negative and in her2neu amplified), also we noticed that de novo metastatic disease, patient who are not heavily pretreated tumors and patients with the anthracycline-sensitive tumor get more benefit from PLD than others.