Association of plasma leptin, pro‐inflammatory adipokines and cancer‐related fatigue in early‐stage breast cancer patients: A prospective cohort study

Abstract

Cancer‐related fatigue (CRF) is subjective and has wide inter‐individual variability. Given that leptin is commonly associated with fatigue syndrome, its use as a potential biomarker for CRF is being investigated. The primary objective of this study was to evaluate the association between leptin and CRF in early‐stage breast cancer patients receiving chemotherapy. In a prospective cohort study, patients completed assessments at baseline (T1), during chemotherapy (T2) and after chemotherapy (T3). Levels of plasma leptin and adipokines were measured using a Luminex bead‐immunoassay and CRF was measured using the Multi‐Dimensional Fatigue Symptom Inventory‐Short Form (MFSI‐SF). Data were analysed longitudinally using a generalised estimating equation incorporating clinically relevant parameters and pro‐inflammatory adipokines. The analysis included 136 patients (mean age ± SD = 51.5 ± 8.8 years; 69.1% receiving anthracycline‐based chemotherapy). More patients experienced CRF at T3 (23.8%) than at T2 (13.8%) compared to baseline. An increase was observed in the median plasma leptin level at T2, followed by a decrease at T3 (T1: 4.07 ng/mL, T2: 4.95 ng/mL and T3: 3.96 ng/mL). In the multivariate model, the change in leptin levels over time was significantly associated with the total MFSI‐SF score ( β = −0.15, P = 0.003) after adjusting for the tumour necrosis factor‐α (TNF‐α) level, anxiety, depression, insomnia, age, menopausal status and type of chemotherapy. This is the first study to report leptin as a biomarker that predicts the onset of CRF over time. Future studies are required to validate the findings.

Involvement of TNF-alpha and IL-10 in breast cancer and patient survival

“…Whereas effective containment of the insult promotes tissue repair, failure to resolve the injury leads to persistent cytokine production and exacerbation of tissue destruction. Thus, host reactions to cellular stress impact on several stages of cancer formation and progression [9]. The present study investigated the involvement of TNF-α and IL-10 in the pathogenesis of breast cancer in vivo, as well as the effectiveness of ten Chinese herbal compounds on MCF-7 cell proliferation in vitro.…”

“…Therefore, improved or targeted therapies are urgently needed to combat metastatic breast cancer [8]. Tumor necrosis factor α (TNF-α) and IL-10, two key molecules in inflammatory responses, cell organization and innate immunity, participate in the pathogenesis of breast cancer [9]. As a cytokine involved in systemic inflammation, TNFα plays a key role in acute phase reaction.…”

Fatigue and lethargy in palliative care

“… Cancer causing persistent inflammation, which in turn causes fatigue (Bower, 2007) Immune alteration of neuroendocrine pathways, which causes behavioural changes such as low mood and sleep disturbances (Gutstein, 2001, Miller et al., 2008; Xiao et al., 2008) Baseline leptins levels and their ability to predict the severity of cancer-related fatigue (Toh et al., 2019) …”

“…Baseline leptins levels and their ability to predict the severity of cancer-related fatigue (Toh et al., 2019)…”

Combined effects of acupuncture and auricular acupressure for relieving cancer-related fatigue in patients during lung cancer chemotherapy

“…Traditional Chinese medicine (TCM) holds that the pathological mechanism of CRF mainly includes the lack of vital qi, deficiency of qi and blood, yin and yang, and viscera asthenia, accompanied by an accumulation of phlegm or dampness, stagnation of qi or stasis of blood. [4][5][6] Consequently, TCM believes that regulating the viscera and tonifying qi and blood are keys to the successful treatment of CRF. In TCM, acupuncture is often used alone or in combination with auricular acupressure to replenish qi and blood.…”