The role of liposomal anthracyclines in metastatic breast cancer

Anthracyclines (doxorubicin and epirubicin) have traditionally occupied a central place in the treatment of early and advanced breast cancer. In patients with metastatic breast cancer (MBC), anthracycline containing regimens have been shown to be superior in terms of activity and efficacy to non antharcycline containing regimens. However, the incidence of cardiac toxicity related to conventional anthracycline use prevents their administration especially in advanced disease, where higher cumulative doses are needed due to the wide use of these agents in the adjuvant setting. In more recent years, new liposomal formulations of doxorubicin, mainly non pegylated doxorubicin (NPLD) and pegylated doxorubicin (PLD), were developed and are now available for clinical use in MBC. Both agents showed a level of activity and efficacy similar to conventional anthracyclines in head to head comparisons, with an improved cardiac safety profile. This peculiarity also led to the development of very active and safe combinations with trastuzumab in HER-2 positive disease, opening new treatment scenarios in this setting. This review summarizes available evidence on the use of liposomal anthracyclines in advanced breast cancer, including HER-2 positive disease.