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

REFERENCES

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.

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