Breast Cancer Chemotherapy Adverse Effects

  • Peripheral neuropathies:
    • Induced by chemotherapy are an increasingly frequent problem
      • Typically, the appearance of drug-induced peripheral neurotoxicities is:
      • Predominantly sensory:
        • Length-dependent
        • Develop after cumulative doses
    • However:
      • Immediate neurologic effects:
        • Can appear with taxane-based therapy and platin derivatives
    • Paclitaxel:
      • Is slightly more neurotoxic than docetaxel
    • Most chemotherapy-induced neuropathies:
      • Are sensory:
        • Tingling or numbness in the feet or fingers:
          • Is often an early sign
    • The risk of developing severe taxane-induced chemotherapy-induced peripheral neuropathies:
      • Is related to the treatment interval:
        • The use of an albumin-bound paclitaxel formulation:
          • Abraxane:
            • Seems to be less neurotoxic
  • Cardiotoxicity:
    • Is more common after doxorubicin-based chemotherapy regimens
    • In this setting:
      • Cardiomyopathy can be acute or chronic:
        • In the acute setting:
          • Doxorubicin cardiotoxicity:
            • Can occur within 2 to 3 days of its administration
          • Occurs with an incidence of:
            • Approximately 11%
          • Patients may experience:
            • Chest pain, palpitations, paroxysmal nonsustained supraventricular tachycardia, and premature atrial and ventricular beats
          • It is hypothesized that this cardiomyopathy may be due to:
            • Reversible myocardial edema
      • Chronic doxorubicin cardiotoxicity:
        • Occurs in about:
          • 1.7% of patients
        • Is usually evident:
          • Within 30 days of administration of its last dose:
            • But can occur up to 10 years later
    • The incidence of doxorubicin cardiomyopathy is primarily related to its dose:
      • Is reported to be about:
        • 4% when the dose is 500 to 550 mg/m2
        • 18% when 551 to 600 mg/m2
        • 36% when the dose exceeds 600 mg/m2


  1. Hahn KM, Johnson PH, Gordon N, et al. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer. 2006;107(6):1219-1226.
  2. Conlin AK, Seidman AD, Bach A, et al. Phase II trial of weekly nanoparticle albumin-bound paclitaxel with carboplatin and trastuzumab as first-line therapy for women with HER2-overexpressing metastatic breast cancer. Clin Breast Cancer. 2010;10(4):281-287.
  3. Chatterjee K, Zhang J, Honbo N, Karliner JS. Doxorubicin cardiomyopathy. Cardiology. 2010;115(2):155–162.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastCancer #BreastExpert #Cancer

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