A Review of Cardiac Safety Surveillance in Breast and Ovarian Cancer Patients Receiving Pegylated Liposomal Doxorubicin (PLD): Cardiac Biomarkers, Neutrophil-to-Lymphocyte Ratio (NLR) and the Role of Pharmacist-Led Cardio-Oncology Counseling

Author

M. AMMULU, S ANJALA, L. ATCHAYA, R. SUBASHINI


Abstract

 Pegylated liposomal doxorubicin (PLD) is an anthracycline used in the management of breast and ovarian cancers. Compared with conventional doxorubicin, PLD provides comparable anticancer efficacy with reduced cardiotoxicity; however, the risk of cardiovascular complications is not completely eliminated, particularly in patients with previous anthracycline exposure or cardiovascular risk factors. Therefore, cardiovascular risk assessment and monitoring are important during PLD therapy. Echocardiography, global longitudinal strain, cardiac troponin, and natriuretic peptides are commonly used for cardiac surveillance and may help in the early identification of cardiac injury. The neutrophil-to-lymphocyte ratio (NLR), obtained from a complete blood count, is an easily accessible marker of systemic inflammation and may provide additional information regarding cardiovascular risk, although its specific role in PLD-induced cardiotoxicity remains uncertain. Pharmacist-led cardio-oncology counseling may support patients by improving medication adherence, recognition of cardiac symptoms, understanding of monitoring requirements, and communication with oncology and cardiology teams. This review focuses on the cardiac safety profile of PLD in breast and ovarian cancer patients, the role of cardiac biomarkers and NLR in cardiac surveillance, and the contribution of pharmacists to patient education and monitoring. Although PLD has a more favorable cardiac safety profile than conventional doxorubicin, continued surveillance remains important. Baseline cardiovascular risk assessment, echocardiographic evaluation, biomarker monitoring, and regular follow-up can support early recognition of cardiovascular complications. NLR may be considered an exploratory inflammatory marker, but prospective research is required to establish its predictive value. Pharmacist-led counseling may complement cardio-oncology care by promoting patient awareness, adherence, symptom recognition, and appropriate referral.



Keywords

Pegylated Liposomal Doxorubicin, Cardiac Safety Surveillance, Cardiac Biomarkers, Neutrophil-to-Lymphocyte Ratio, Pharmacist-Led Counseling



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