Efficacy and safety of mitoxantrone hydrochloride liposome injection in Chinese patients with advanced breast cancer: a randomized, open-label, active-controlled, single-center, phase II clinical trial

Leiping Wang, Jun Cao, Chunlei Li, Xiaodong Wang, Yannan Zhao, Ting Li, Yiqun Du, Zhonghua Tao, Wenxia Peng, Biyun Wang, Jian Zhang, Sheng Zhang, Zhonghua Wang, Xichun Hu, Leiping Wang, Jun Cao, Chunlei Li, Xiaodong Wang, Yannan Zhao, Ting Li, Yiqun Du, Zhonghua Tao, Wenxia Peng, Biyun Wang, Jian Zhang, Sheng Zhang, Zhonghua Wang, Xichun Hu

Abstract

Purpose: This trial aimed to evaluate the efficacy and safety of mitoxantrone hydrochloride liposome injection (Lipo-MIT) in advanced breast cancer (ABC).

Methods: In this randomized, open-label, active-controlled, single-center, phase II clinical trial, eligible patients were randomized in a ratio of 1:1 to receive Lipo-MIT or mitoxantrone hydrochloride injection (MIT) intravenously. The primary endpoint was objective response rate (ORR). The secondary endpoints were disease control rate (DCR), progression-free survival (PFS), and safety outcomes.

Results: Sixty patients were randomized to receive Lipo-MIT or MIT. The ORR was 13.3% (95% confidence interval (CI): 3.8-30.7%) for Lipo-MIT and 6.7% (95% CI: 0.8-22.1%) for MIT. The DCR was 50% (95% CI: 31.3-68.7%) with Lipo-MIT vs. 30% (95% CI: 14.7-49.4%) with MIT. The median PFS was 1.92 months (95% CI: 1.75-3.61) for Lipo-MIT and 1.85 months (95% CI: 1.75-2.02) for MIT. The most common toxicity was myelosuppression. Lipo-MIT resulted in an incidence of 86.7% of leukopenia and 80.0% of neutropenia, which was marginally superior to MIT (96.7% and 96.7%, respectively). Lipo-MIT showed a lower incidence of cardiovascular events (13.3% vs. 20.0%) and increased cardiac troponin T (3.3% vs. 36.7%); but higher incidence of anemia (76.7% vs. 46.7%), skin hyperpigmentation (66.7% vs. 3.3%), and fever (23.3% vs. 10.0%) than MIT. Conclusions The clinical benefit parameters of Lipo-MIT and MIT were comparable. Lipo-MIT provided a different toxicity profile, which might be associated with the altered distribution of the drug. Additional study is needed to elucidate the potential benefit of Lipo-MIT in ABC.

Clinical trial registration: This study is registered with ClinicalTrials.gov (No. NCT02596373) on Nov 4, 2015.

Keywords: Breast neoplasms; Efficacy; Liposomes; Mitoxantrone; Safety.

Conflict of interest statement

Chunlei Li, and Xiaodong Wang are staff of CSPC ZhongQi Pharmaceutical Technology (Shijiazhuang) Co., Ltd. The others declare that they have no conflicts of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
A waterfall plot of the best percent change from baseline in the sum of the diameters of the target lesions. Panel a shows the result of Lipo-MIT group, Panel b shows the result of MIT group
Fig. 2
Fig. 2
A swimmer plot of the objective responses according to RECIST (version 1.1) from the start of treatment to the end of treatment. Panel a shows the result of Lipo-MIT group, Panel b shows the result of MIT group. Each horizontal bar represents one patient. The treatment duration was defined as the time from the first treatment to the time of documented progression, withdrawal, death, or completion of full course of treatment. PD: progressive disease; PR: partial response; SD: stable disease; NA: not available

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