I'm wondering if any of you have come across a link between the "taxane" chemo drugs (Taxotere/docetaxel and Taxol/paclitaxel) and the development of LE.
In my spare-time reading of medical articles*, I've found some that say the fluid retention and edema caused by the taxane drugs is a type of "capillary leak syndrome" (i.e., not just plain old edema). It is dose-dependent; in several studies the median time to onset was around 60 days of treatment and the median dose to onset was around 300 mg per meter-squared. Thus, it takes a few cycles to develop, and it gets worse with each successive cycle. Women are given Decadron (dexamethasone) to try to minimize the fluid retention.
What really worried me about all this was the description of the mechanism of the fluid retention caused by the taxanes. Apparently, it starts with a disturbance in the permeability of capillaries, which allows small proteins and fluid to escape from the blood and into the surrounding tissue. The earliest sign of the fluid retention is soft, pitting edema, especially in the feet and ankles but progressing up the legs and even to the hands and face. At first (and probably during the early treatment cycles), the lymphatic drainage system works as it should, and the fluid and proteins are carried back into the vascular system through lymphatic vessels.
Eventually, though, the lymphatic drainage system becomes impaired and is no longer able to resorb all the fluid. With the failure of the lymphatic drainage system, the fluid retention becomes more severe and self-sustaining. The edematous tissue becomes firm, and can even develop into something called "scleroderma".
All this sounds remarkably like lymphedema, doesn't it? So, have any of you developed LE after undergoing a chemo regimen that included Taxotere or Taxol?
otter
*For example: A. Behar et al. 1997: The pathophysiological mechanism of fluid retention in advanced cancer patients treated with docetaxel, but not receiving corticosteroid comedication. British Journal of Clinical Pharmacology 43:653-658.
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RIV54 Joined: Apr 2007 Posts: 293 |
May 12, 2008 06:36 pm
RIV54 wrote:
Actually otter, I didn't give it much thought 'til I read your post, but my lymphedema didn't occur until after may last TAC treatment. That was 4 months from my mastectomy. It started before my radiation tx, also. I've been through PT and have a custom sleeve and glove and exercises so I'm hoping I can at least keep it under control. PT says my lymphedema is mild. Its something to think about. Gina
Dx 3/9/2007, IDC, 2cm, Stage IIIa, 6/25 nodes, ER+/PR-, HER2- |
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revkat Joined: Apr 2008 Posts: 206 |
May 12, 2008 07:14 pm
revkat wrote:
Otter, once again you have nailed one of my concerns! I don't have the answer, but I've wondered just because of how things feel in my arm pit and along my arm, it seems like the cording is getting worse, not better, and I do keep doing my exercises. It also feels like my arm is better while I'm on the steriods and then gets to feeling all stiff and achey when I go off them. Dx 1/27/2008, IDC, 2cm, Stage IIa, Grade 2, 1/20 nodes, ER+, HER2- |
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txred9876 Joined: Aug 2005 Posts: 559 |
May 13, 2008 04:49 pm
txred9876 wrote:
my le showed up just after completing 12 weekly doses of Taxol. This was June of 06 and it has returned. tina |
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SpunkyGirl Joined: Sep 2006 Posts: 442 |
May 15, 2008 12:02 am
SpunkyGirl wrote:
Otter, The day after my second Taxol treatment, I ran a local 5-K. The next day, while I was taking stuff off our Christmas tree, I suddenly got these strange feelings of heaviness in my hand and arm (surgery side). I had a couple of sleeves to wear for exercising, and I put one on and didn't take it off for several days (except to sleep). It honestly freaked me out, because I could feel something going on in there. I am so glad I went with my instinct, because I am sure that if I hadn't been proactive, I would have ended up with a nasty case of LE. Yes, I do believe that chemo in general has been show to be an LE trigger. With that being said, I'm concerned that you might be reading a little too much! I'm a "researcher" just like you, but I've found that each of our experience with BC is all over the board. You need to be proactive and cautious, but don't let this stuff rule your thoughts all the time. Does that make sense? Bobbie Every day is a blessing...
Dx 7/23/2006, IDC, <1cm, Stage IIIa, Grade 2, 8/20 nodes, ER+/PR-, HER2+ |
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otter Joined: Jan 2008 Posts: 2359 |
May 15, 2008 01:34 am, edited May 15, 2008 01:36 AM
by otter
otter wrote:
Bobbie, you're right--I probably do read too much. It was the (now-retired) biomedical scientist in me that asked the question. I have always been interested in the "mechanisms" that explain how and why biological things happen. I am inherently curious about such things. Long ago, I figured out a way to separate myself from the stuff I'm learning, and reach sort of a 3rd-party observer status. So, even though I'm curious about a possible connection between Taxotere and LE, I am not actively worrying about my situation. Taxotere is pretty rough, but I chose it over the main alternative (Adriamycin) and at the recommendation of my onco. I would not go back on that decision, even if I thought there was an increased risk of LE with Taxotere. (The long-term SE's of Adriamycin are pretty daunting, too.) What I've found is what you've said--the value of this type of knowledge is to let me be cautious and pro-active--not to cause me to be paranoid. So, yes, your advice makes perfect sense. Thanks! otter Dx 1/14/2008, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2- |
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FLgaltg Joined: Feb 2007 Posts: 1 |
May 22, 2008 10:48 am
FLgaltg wrote:
NO one has ever suggested this to me, but now that I am thinking back....had last dose of Taxotere in August, then Breast (not arm) lymphedema ever since. I have wonderful therapist trained in the Vodder method of manual lymph drainage. But has to be maintained by me at home. Pain is not reduced, just fullness. |
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bomber410 Joined: Apr 2007 Posts: 477 |
May 22, 2008 01:34 pm
bomber410 wrote:
I thought I responded to this one already. I say 'Yes'. I had the two node surgeries - sentinel node biopsy and complete axillary. 10 nodes removed. I had the 4 ACs during which I kept hiking, running, biking, etc. I had my first of 4 Taxoteres after which I did the Komen BC 3-day 60 miles in 90+F temperatures. No problem up to this point. Sometime around the 3rd/4th Taxotere, my knuckles disappeared, arm swollen, truncal swelling. I've been dealing with LE ever since. I did also have the radiation treatment but radiation is not what triggered LE. I know it doesn't help. :-) Hang in there. There is some ease to the LE once the edema from the Taxotere lessens over the few months following completion of treatment. LE didn't go away for me but did ease some. Debbie You can visit my CaringBridge site at http://www.caringbridge.org/visit/debbiecole
Dx 3/29/2007, IDC, 2cm, Stage II, Grade 2, 1/10 nodes, ER+/PR+, HER2- |
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