Effective Management of Chemotherapy-Induced Cardiotoxicity: A Prospective Follow-Up Study on Alternative Regimens in Bangladeshi Cancer Patients

Background Chemotherapy-induced cardiotoxicity remains a major barrier to optimal cancer treatment, often necessitating regimen switches in vulnerable populations. Building on prior evidence of high cardiac complication rates in Bangladeshi patients, this follow-up study evaluates the efficacy along with the safety of alternative chemotherapy protocols post-toxicity. Objective This study aimed to compare the clinical outcomes among patients switched to liposomal doxorubicin versus non-anthracycline alternatives in patients who discontinued initial regimens due to cardiotoxicity, with a focus on tumor response, cardiac recovery, and survival outcomes. Methodology This prospective follow-up study, conducted from April 2023 to September 2025 at Bangladesh Medical University, enrolled 112 patients (subset of a prior 339-patient cohort) aged >18 years with histologically confirmed cancer and post-treatment cardiotoxicity (defined by elevated troponin-I >0.04 ng/mL, N-terminal pro-brain natriuretic peptide (NT-proBNP) >125 pg/mL, or left ventricular ejection fraction (LVEF) decline ≥10%). Initial regimens included doxorubicin (42%), epirubicin (18%), taxanes (paclitaxel/docetaxel/nab-paclitaxel; 25%), and fluoropyrimidines (5-fluorouracil/capecitabine; 15%), all discontinued due to toxicity. Patients were switched to liposomal doxorubicin (n=73) or non-anthracycline protocols (e.g., gemcitabine-based; n=39). Assessments at three, six, and 12 months included the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 tumor response, echocardiography (ECHO), electrocardiography (ECG), and biomarkers. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, New York, United States), with chi-squared tests for categorical variables, paired t-tests for continuous outcomes, and Kaplan-Meier for survival; p<0.05 was considered as the level of significance. Treatment switching was clinically determined based on tumor type and cardiac risk, not randomized. Results The mean age was 53.2±9.8 years (58% female). Cancers included lung (28%), breast (22%), and cervix (12%). All patients discontinued initial therapy after a mean of 2.4 cycles. Liposomal doxorubicin was associated with better response and cardiac recovery in this cohort where the objective response rate was 78% (partial: 66%; complete: 12%) versus 33% in alternatives (p<0.001), LVEF improvement was +8.2%±3.1% versus +2.1%±1.8% (p=0.002), and troponin-I reduction was -65% versus -28% (p<0.001). Twelve-month overall survival was 85% versus 61% (p=0.003). Socioeconomic status showed no association with outcomes (p=0.42). No severe cardiac events recurred in the liposomal group. Conclusion Liposomal doxorubicin emerges as the most effective alternative, enabling safe treatment continuation with preserved oncologic efficacy and improved cardiac recovery. In resource-limited settings like Bangladesh, prioritizing liposomal formulations for high-risk patients could mitigate cardiotoxicity burdens. Integrated cardio-oncology protocols are recommended.