Maintenance Liposomal Doxorubicin Following Induction Doxorubicin in Soft Tissue Sarcoma: A Single-Center Observational Study

Maintenance chemotherapy prolongs progression-free survival (PFS) in several malignancies, but its role in soft tissue sarcoma (STS) remains unclear. Conventional doxorubicin is limited by cumulative toxicities. Liposomal doxorubicin may allow prolonged therapy. We evaluated outcomes of patients treated with maintenance liposomal doxorubicin following induction doxorubicin. This was a single-center retrospective study using the Quebec Sarcoma Registry from 2015 to 2025. Eligible patients had histologically confirmed STS and received doxorubicin-based induction therapy. Those achieving disease control were treated with maintenance liposomal doxorubicin. Clinical variables, adverse events, and outcomes were collected, and PFS and overall survival (OS) were estimated using the Kaplan–Meier method. Twenty-four patients were included (median age 61 years; 62.5% male), with leiomyosarcoma and undifferentiated pleomorphic sarcoma as the most frequent histologies. The median induction exposure was six cycles, and maintenance treatment was administered for a median of five cycles. Median PFS was 11.4 months, and median maintenance PFS was 6.1 months. Infusion reactions and hematologic toxicities were the most common adverse events. Median OS was 60.2 months. Maintenance liposomal doxorubicin was feasible, well-tolerated, and associated with encouraging disease control in selected patients, supporting further prospective evaluation.