Delayed Neoplastic and Renal Complications in Women Receiving Long-term Chemotherapy for Recurrent Ovarian Cancer

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Despite effective platinum-based induction chemotherapy, the majority of women who present with epithelial ovarian cancer are not cured. Upon recurrence, disease control seldom, if ever, exceeds what is achievable with the initial treatment ( 1 , 2 ). Pegylated liposomal doxorubicin (PLD; Doxil [Centocor Ortho Biotech, Inc, Horsham, PA], Caelyx [Schering-Plough, Kenilworth, NJ]) alone or in combination with other drugs is now part of the treatment for both platinum-sensitive (with carboplatin) ( 3 ) and platinum-resistant ( 4 ) recurrences of epithelial ovarian cancer. We ( 5 ) and others ( 6 ) have previously reported on the cardiac and overall safety of PLD after its prolonged administration with seemingly excellent long-term control of disease in selected patients. We reported that seven of the original 16-patient “maintenance cohort” received PLD every 4–7 weeks (treatment interval adjusted to reduce skin toxicity) for at least 4 years with an acceptable quality of life ( 5 ). Of note, four of these patients had a deleterious mutation in BRCA1 or BRCA2 . After further follow-up, however, the occurrence of nonovarian malignancies as well as chronic renal disease and hypertension ( Table 1 ) raises questions about the relationship between these side effects and prolonged treatment with PLD. Therefore, we wish to increase awareness of a possible risk increased risk for neoplastic and renal complications in women receiving long-term treatment with PLD for ovarian cancer.