Objective: Pegylated liposomal doxorubicin (PLD) is a stealth liposomal form of doxorubicin that has been approved for the treatment of patients with relapsed ovarian cancer. Previous studies have shown a response rate of about 25% in patients who had treatment failure with prior platinum- and/or paclitaxel-based regimens. Our purpose was to determine the anti-tumor activity of PLD in Asian patients with both platinum- and paclitaxel- refractory epithelial ovarian cancer, and to evaluate the toxicity of this drug in these heavily pretreated patients. Materials and Methods: Between January 2000 and December 2003, 18 patients with documented relapsed disease, who had had prior treatment with both platinum- and paclitaxel-based regimens within 6 months, were enrolled. They were treated with PLD 40 mg/m2 intravenous infusion every 4 weeks. Anti-tumor responses and adverse effects were evaluated based on WHO criteria and Common Toxicity Criteria, respectively. Results: All 18 patients were assessable for response and toxicity. Five patients (27.8%) experienced a response (3 complete responses, 2 partial responses), four patients (22.2%) had stable disease, while nine patients (50.0%) had progressive disease. The median progression-free survival was 14 weeks. Median overall survival was 48 weeks. There was no grade 3 or 4 leukopenia or thrombocytopenia. Non-hematologic toxicities included grade 2 hand-foot syndrome in one patient and grade 1 stomatitis in three patients. Two patients experienced severe skin pigmentation. There was no treatment delay due to toxicity. Conclusion: PLD at a dose of 40 mg/m2 every 4 weeks was generally well tolerated and effective, even for a heavily pretreated Asian population. These results may provide some information for further clinical trials integrating PLD with front-line therapy.