Predicting Risk of Lymphedema in Breast Cancer

Researchers have developed a tool that considers several patient and treatment characteristics in order to predict the risk of lymphedema after axillary lymph node dissection (removal of several under-the-arm lymph nodes) for breast cancer. These results will be presented at the 2011 Breast Cancer Symposium.????

Lymphedema refers to swelling due to an accumulation of lymph fluid. Women with breast cancer may develop lymphedema in an arm after axillary lymph nodes are removed. More extensive removal of lymph nodes (known as axillary lymph node dissection) is more apt to cause lymphedema than the removal of only a small number of nodes (known as a sentinel lymph node biopsy), but lymphedema can occur following either procedure.??

Roughly one-third of women who undergo axillary lymph node dissection develop lymphedema. Tools to help manage lymphedema include manual lymphatic drainage, use of compression bandages and garments, training in skin and nail care (in order to reduce the risk of infection), and instruction in exercises.???

Among women who undergo axillary lymph node dissection, it’s been uncertain why some women develop lymphedema and others don’t. In order to predict which women are at highest risk of lymphedema, researchers explored how lymphedema risk varied by patient characteristics and type of cancer treatment.?

Factors that were linked with lymphedema risk included age, body mass index, infusion of chemotherapy into the arm on the same side of the body as the breast cancer, extent of lymph node removal, location of the radiotherapy field, postoperative seroma (fluid build-up), infection, and early edema (swelling). An initial estimate of lymphedema risk can be obtained prior to surgery, and risk estimates can then be modified based on information collected after surgery.?

The statistical models had an accuracy of more than 70% for the prediction of lymphedema. Although these models continue to be refined, they could eventually provide important tools for counseling and managing women before and after axillary lymph node dissection.???

Reference: Bevilacqua JLB, Kattan MW, Yu C et al. Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast cancer. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 8.?

Posted September 12, 2011

View the original article here

Predicting Nerve Damage from Paclitaxel

The chemotherapy drug paclitaxel can cause nerve damage in some patients. According to a study that will be presented at the 2011 annual meeting of the American Society of Clinical Oncology, specific genetic markers may eventually allow doctors to know in advance which patients are most likely to experience this side effect.?

Peripheral neuropathy—a condition that can cause pain, burning, tingling, or numbness in the hands and feet—is a potential side effect of taxane chemotherapy drugs such as paclitaxel. The condition can become severe, and may limit the amount of chemotherapy that a patient can receive. ?

To explore the possibility that specific genetic markers may be linked with the development of peripheral neuropathy, researchers collected information about more than 2,000 women who were participating in a breast cancer clinical trial. All the patients received paclitaxel.?

Genetic differences between women who did and did not develop peripheral neuropathy were identified through a process known as a genome-wide association study (GWAS). The researchers scanned complete sets of DNA for small genetic variations known as single-nucleotide polymorphisms (SNPs). ?

Several SNPs were linked with the likelihood of peripheral neuropathy. Results for one of these SNPs, for example, indicated that risk of neuropathy was 27% among patients without the genetic variation (no SNP), 40% among patients with one SNP, and 60% among patients with two SNPs. Neuropathy was also more common in older patients and in African Americans. ?

In a prepared statement, the lead author of the study noted “If these findings can be replicated, this may allow physicians to know prior to recommending therapy?

whether the patient is at an inordinate risk for developing taxane-induced neuropathy. This may allow for better counseling, use of alternative drugs or schedules, or omission of taxanes in the appropriate settings. These genetic findings might also provide insight into the mechanism of this side effect and help develop drugs to prevent this toxicity altogether.”?

Reference: Schneider BP, Li L, Miller K et al. Genetic associations with taxane-induced neuropathy by genome wide association study (GWAS) in E5103. Paper presented at: 2011 Annual Meeting of the American Society of Clinical Oncology; June 3-7, 2011; Chicago, IL. Abstract 1000.?

View the original article here