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The benefits and risks of liposomal-based doxorubicin versus conventional doxorubicin for metastatic breast cancer: A systematic review and meta-analysis

Author: Gabrielle F. Babao*, Angelica Marie G. Tan, Maria Patricia S. Ugalde, Mac Ardy Gloria

Category: Pharmacy


This study aims to qualitatively and quantitatively synthesize the clinical benefits and risks of liposomal-based doxorubicin (PLD/LD) compared with conventional doxorubicin (DOX) as treatment for metastatic breast cancer among adult female patients. Five electronic databases were searched for literature published from inception to February 23, 2022. Eligible studies included original articles which studied adult female patients with metastatic breast cancer, directly compared PLD/LD with DOX, described the outcomes of interest, and employed RCTs at least in phase II. Four RCTs were included out of 6,837 screened studies. Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2) was utilized for assessment. Data was extracted and analyzed qualitatively and quantitatively using frequency statistics. Estimates were pooled using random-/fixed- effects models and sources were explored for heterogeneity. Subgroup analysis and publication bias assessment were conducted. Testing for heterogeneity, PLD/LD was associated with significantly reduced likelihood of cardiotoxicity (RR = 0.336, 95% CI 0.198 to 0.570) and vomiting (RR = 0.651, 95% CI 0.502 to 0.845), however there was no significant difference in overall survival (HR = 0.893, 95% CI 0.747 to 1.040). Results were synthesized using a PRISMA Flowchart, all pertinent information from the journal articles were tabulated, and forest and funnel plots were generated. It was found that the benefits of PLD/LD overall outweigh the clinical risks. Caution is advised when interpreting the results since many of these are deemed insignificant due to insufficient data.

Keywords: metastatic breast cancer, conventional doxorubicin, liposomal-based doxorubicin, clinical benefits, clinical risks