Liposomal anthracyclines

Doxorubicin and daunorubicin have been produced in encapsulated forms in which the anthracycline drug is trapped within phospholipid spheres known as liposomes. These liposomal preparations have a prolonged circulatory halflife and are associated with enhanced delivery of active drug to KS lesions. They have been compared with standard combination chemotherapy in large randomised trials.60-62 A randomised crossover study of 29 patients with early AIDS-related KS (<20 cutaneous lesions, no visceral involvement and a CD4 count >400 x 106/litre) randomised patients between initial liposomal daunorubicin and observation for 12 weeks.63 Fifteen patients received liposomal daunorubicin, 40 mg/m2 every 2 weeks for six cycles, and 14 patients were observed. ACTG criteria were used to assess response and patients crossed over after 12 weeks or on disease progression. There was a 40% initial response rate in the liposomal daunorubicin arm. Forty per cent of these patients developed progressive disease, compared with 72% in the observation arm.

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