Adjuvant Taxane-Based Chemotherapy Is Not Associated With Increased Risk of Lymphedema, Study Finds
In women with breast cancer, taxane-based chemotherapy—docetaxel and paclitaxel—did not appear to increase the incidence of lymphedema, according to a study by Swaroop et al in Breast Cancer Research and Treatment. However, the investigators did note that adjuvant chemotherapy with docetaxel was a significant risk factor for mild arm swelling.
Although taxane-based chemotherapy for the treatment of breast cancer is associated with fluid retention in the extremities, its possible connection with lymphedema has not been documented. Women treated for breast cancer face a lifetime risk of developing lymphedema, which is known to have a significant effect on quality of life. According to one study, one in five survivors of breast cancer will develop this complication. The occurrence of lymphedema in these patients may be associated with chemotherapy, but further investigation has been needed to evaluate the correlation between the two factors.
Thus, Swaroop and colleagues investigated the effect of taxane-based chemotherapy on women with breast cancer. Taxane-based chemotherapy included docetaxel, paclitaxel, and albumin-bound paclitaxel.
Study Details
Included in the study were 1,121 women who were diagnosed with unilateral breast cancer. All underwent unilateral beast surgery and screening for lymphedema. Lymphedema was defined as a ≥ 10% relative volume change occurring more than 3 months postoperatively.
In total, 29% (324 patients) of the cohort received adjuvant taxane chemotherapy, 6% (62 patients) received nontaxane chemotherapy, and the remaining 66% (735 patients) received no chemotherapy. Of the 324 patients who received taxane-based chemotherapy, 56% (181) were treated with paclitaxel, 40% (131) were treated with docetaxel, and 3% (9) were treated with albumin-bound paclitaxel.
Cumulative Incidence of Lymphedema
In the overall cohort of women, the 2-year cumulative incidence of lymphedema was 5.27% (95% confidence interval [CI] = 4.10%–6.76%). In the group receiving taxane chemotherapy, the cumulative incidence was 10.29% (95% CI = 7.43%–14.18%). In those receiving non–taxane-based chemotherapy, the cumulative incidence was 4.87% (95% CI = 1.60%–14.33%). The cumulative incidence was 3.07% in those patients who did not receive chemotherapy (95% CI = 2.03%–4.63%).
Mild swelling was seen in 16.37% of the overall cohort, and the cumulative incidence was higher in patients receiving taxane-based chemotherapy (22.76%). In contrast, only 7.05% of patients receiving non–taxane-based chemotherapy and 14.64% of those who did not receive chemotherapy had mild swelling.
In patients who did develop lymphedema, the median time from final surgery to the onset of lymphedema was 19.97 months in the nonchemotherapy group, 20.72 months in the nontaxane chemotherapy group, and 19.41 months in the taxane chemotherapy group.
Increased Risk of Mild Swelling but Not Lymphedema
On univariate analysis, taxane-based chemotherapy was associated with a significantly increased risk of lymphedema compared with no chemotherapy (hazard ratio [HR] = 2.61, P < .0001) and nontaxane chemotherapy (HR = 2.90, P = .0412). However, this association did not persist on multivariate analysis, which found no significantly increased risk of lymphedema for taxane-based chemotherapy compared to no chemotherapy (HR = 1.14, P = .6188) and nontaxane chemotherapy (HR = 1.56, P = .3988). In addition, when analyzed individually, neither paclitaxel nor docetaxel were significantly associated with increased lymphedema risk.
Taxane-based chemotherapy was associated with a slight increase in mild swelling compared with no chemotherapy and nontaxane chemotherapy. Docetaxel, but not paclitaxel, was significantly associated with increased risk of mild swelling compared with no chemotherapy (HR = 1.63, P = .0098) and nontaxane chemotherapy (HR = 2.15, P = .0195).
Closing Thoughts
According to the investigators, the results of this study demonstrated that adjuvant taxane-based chemotherapy with either paclitaxel or docetaxel was not significantly associated with an increased risk of lymphedema. However, the investigators did note that adjuvant chemotherapy with docetaxel was a significant risk factor for mild arm swelling.
The investigators emphasized, “Although arm volume changes should be regularly monitored for early signs of progression, it is important for clinicians to differentiate between treatment-related risk factors for developing chronic edema versus mild or transient edema that may resolve without intervention. This may help patients avoid costly treatment expenses and potentially reduce the fear of lymphedema.”
Alphonse G. Taghian, MD, of the Massachusetts General Hospital, Boston, is the corresponding author of this article in Breast Cancer Research and Treatment.
This study was supported by grants from the National Cancer Institute and the Adele McKinnon Research Fund for Breast Cancer–Related Lymphedema. The authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
