Adjuvant chemotherapy-associated lipid changes in breast cancer patients

He, Tao; Wang, Cheng-shi; Tan, Qiuwen; Wang, Zhu; Li, Jiayuan; Chen, Tao; Cui, Kaijun; Wu, Yunhao; Sun, Jiani; Zheng, Danxi; Lv, Qing; Chen, Jie

doi:10.1097/md.0000000000021498

Cited by 25 publications

(28 citation statements)

References 48 publications

(44 reference statements)

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“…It was reported that cytotoxic drugs affect blood lipid metabolism differently [ 20 ]. Breast cancer patients often display increased total cholesterol, LDL-C, and TG levels during chemotherapy [ 15 – 18 ], while colorectal cancer patients treated with chemotherapy show increased HDL-C and decreased LDL-C [ 19 ]. However, it remains unclear whether lipid alterations exist in NSCLC patients receiving standard adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Predictive value of a reduction in the level of high-density lipoprotein-cholesterol in patients with non-small-cell lung cancer undergoing radical resection and adjuvant chemotherapy: a retrospective observational study

et al. 2021

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Background Cancer patients often exhibit chemotherapy-associated changes in serum lipid profiles, however, their prognostic value before and after adjuvant chemotherapy on survival among non-small-cell lung cancer (NSCLC) patients is unknown. Methods NSCLC patients undergoing radical resection and subsequent adjuvant chemotherapy from 2013 to 2017 at Sun Yat-sen University Cancer Center were retrospectively reviewed. Fasted serum lipid levels were measured before and after chemotherapy. The optimal lipid cut-off values at baseline and fluctuation were determined using X-tile™. The fluctuations in serum lipid levels and disease-free survival (DFS) were assessed. Results Serum cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglyceride, apolipoprotein (Apo) A-I, and ApoB all significantly increased after adjuvant chemotherapy. X-tile determined 1.52 mmol/L of HDL-C and 0.74 g/L of ApoB as the optimal cut-off values before chemotherapy. Patients with HDL-C ≥ 1.52 mmol/L (median DFS: not reached vs. 26.30 months, P = 0.0005) and a decreased HDL-C level after adjuvant chemotherapy (median DFS: 80.43 vs. 26.12 months, P = 0.0204) had a longer DFS. An HDL-C level that increased by ≥ 0.32 mmol/L after chemotherapy indicated a worse DFS. A high baseline ApoB level were associated with a superior DFS. In the univariate analysis and the multivariate Cox analyses, a high baseline HDL-C level and a HDL-C reduction after adjuvant chemotherapy were independent indicators for superior DFS. High baseline HDL-C was related to N0-1 stage (χ2 = 6.413, P = 0.011), and HDL-C fluctuation was significantly correlated with specific chemotherapy regimens (χ2 = 5.002, P = 0.025). Conclusions Adjuvant chemotherapy increased various lipid levels in resected NSCLC patients. A higher HDL-C level before chemotherapy and a reduced HDL-C level after adjuvant chemotherapy were independent predictors of longer DFS in patients with curable NSCLC.

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Section: Discussionmentioning

confidence: 99%

“…Chemotherapy agents can also affect lipid metabolism. A few studies assessed breast cancer patients who received chemotherapy, and discovered significantly increased total cholesterol, LDL-C, and TG levels [ 15 – 18 ]. In colorectal cancer patients, chemotherapy significantly increased HDL-C and decreased LDL-C [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of a reduction in the level of high-density lipoprotein-cholesterol in patients with non-small-cell lung cancer undergoing radical resection and adjuvant chemotherapy: a retrospective observational study

et al. 2021

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“…She and her family reported that her food intake was stable, suggesting that her lipid intake did not change. It has been reported that serum lipid levels, such as triglyceride, total cholesterol, and low-density lipoprotein, were significantly but not severely elevated after chemotherapy in breast cancer treatment [ 11 ]. He et al [ 11 ] speculated that chemotherapy itself can directly cause endothelial dysfunction and insulin resistance, leading to cytokine alterations, resulting in elevated serum lipid levels.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that serum lipid levels, such as triglyceride, total cholesterol, and low-density lipoprotein, were significantly but not severely elevated after chemotherapy in breast cancer treatment [ 11 ]. He et al [ 11 ] speculated that chemotherapy itself can directly cause endothelial dysfunction and insulin resistance, leading to cytokine alterations, resulting in elevated serum lipid levels. They also proposed another possibility that suggests that the enhancement of systemic oxidative stress causes lipid peroxidation, leading to liver dysfunction, and resulting in a decrease in lipid metabolism [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…He et al [ 11 ] speculated that chemotherapy itself can directly cause endothelial dysfunction and insulin resistance, leading to cytokine alterations, resulting in elevated serum lipid levels. They also proposed another possibility that suggests that the enhancement of systemic oxidative stress causes lipid peroxidation, leading to liver dysfunction, and resulting in a decrease in lipid metabolism [ 11 ]. In addition, paclitaxel has been reported to be sufficient to trigger significant alterations in lipid metabolism by increasing hydroperoxide [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Severe Hypertriglyceridemia Induced by Docetaxel: A Novel Case Report

et al. 2021

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Docetaxel (DOC) is one of the most effective agents for breast cancer treatment. Here, we report docetaxel-induced severe hypertriglyceridemia in a patient previously diagnosed with hyperlipidemia and corresponding therapeutic intervention. A postmenopausal woman, with previously controlled hyperlipidemia using rosuvastatin 5 mg daily, was diagnosed with stage IIB breast cancer with human epidermal growth factor receptor-2 overexpression; she received DOC (75 mg/m<sup>2</sup>), pertuzumab, and trastuzumab treatment as neoadjuvant chemotherapy. The serum triglyceride level was mildly higher than normal, and cholesterol level was normal at baseline. The serum triglyceride level was almost stable after chemotherapy initiation but suddenly increased to grade 3 (770 mg/dL) after the third cycle of the treatment without any symptoms. Sustained-release bezafibrate 400 mg was administered, resulting in a significant decrease to the baseline level; bezafibrate was discontinued on day 28 of the fourth chemotherapy as neoadjuvant chemotherapy was completed. The level was stable around the baseline level during adjuvant chemotherapy with pertuzumab and trastuzumab. Therefore, DOC-induced severe hypertriglyceridemia was strongly indicated in this case. The mechanism underlying the symptoms remains unclear; we speculate that it could be a resultant of a decrease in lipid metabolism as the patient had grade 2 diarrhea. Moreover, her backgrounds, such as mild hypertriglyceridemia, postmenopausal, diabetes, and obesity, in addition to DOC administration might have affected the outcome. Fibrate administration and cessation of treatment were as effective as in previous reports. DOC-induced hypertriglyceridemia presents with the possibility of severe complications. Elucidation of the exact mechanisms and epidemiological features is required for better management.

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