Liposomal doxorubicin in first line metastatic HER-2-positive breast cancer for prevention the cardiotoxicity
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We describe a 62 year old female with metastatic HER-2-positive breast cancer, and with independent cardiovascular comorbidities. She was earlier treated with J131 therapy due to thyroid toxicity. She developed grade 2 mitral and tricuspid valvular insufficiency as a result of uncontrolled hypertension. In 2013, the patient was diagnosed with luminal B2 breast cancer with liver and bone metastases, and a large infiltration of the left breast together with the surrounding soft tissue. She was treated with liposomal doxorubicin and cyclophosphamide, with the dose of anthracycline slightly reduced to 50 mg/m2 because of the elevated liver enzymes. She was in complete remission during treatment, without any cardiac or hematologic toxicity. The treatment was prolonged to eight cycles until the liver tests returned to normal. The cumulative dose of liposomal doxorubicin amounted to 400 mg/m2 (with the maximum recommended dose of 600 mg/m2). We decided to administer the liposomal form of doxorubicin, which is less cardiotoxic than conventional doxorubicin, as first-line treatment in order to prevent cardiotoxicity in a patient who is a candidate for another cardiotoxic therapy involving trastuzumab in the future. The patient’s disease progressed 10 months following the completion of first-line therapy. There are no cardiologic contraindications to trastuzumab and there are no signs of liposomal doxorubicin-related cardiotoxicity or deterioration of the valvular insufficiency.
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