Systemic Immune Activation, Anemia and Thrombocytosis in Breast Cancer Patients Treated by Doxorubicin and Paclitaxel

Abstract

Increased urinary concentrations of neoptcrin, an indicator of systemic immune activation, have been reported only in a minority of patients with breast cancer. We determined urinary neopterin by high-performance liquid chromatography in 78 patients with breast carcinoma, including 51 patients treated by systemic administration of doxorubicin and paclitaxel. Urinary neopterin before the therapy was not statistically different in patients compared to controls. Increased neopterin concentrations were more frequent in patients with advanced disease. A statistically significant increase in urinary neopterin, gradual decrease in hemoglobin and an increase in platelet counts were observed during doxorubicin/paclitaxel chemotherapy. The concentration of urinary neopterin before the second cycle of chemotherapy has shown significant negative correlation with the concentrations of hemoglobin later in the course of chemotherapy and a positive corrélation with platelet counts. In conclusion, urinary neopterin is normal in most patients with breast cancer. Increased urinary neopterin concentrations during doxorubicin/paclitaxel chemotherapy indicate the presence of systemic immune activation that seems to be associated with chemotherapy-induced anemia and thrombocytosis.

Urinary Neopterin in Patients with Ovarian Cancer

“…Both paclitaxel and cisplatin have been shown to activate macrophages in vitro (28,29). Recently, we have reported an increase in urinary neopterin in breast cancer patients treated with the combination of paclitaxel and doxorubicin (8). However, in the present study we did not observe an increase in urinary neopterin after paclitaxel/platinum chemotherapy.…”

“…The ovaries are also site of metastatic spread from tumors of other sites, mostly gastrointestinal and breast carcinomas (7). The prevalence of increased urinary neopterin concentrations is high in EOC (Tabie 1), but substantially lower percentages of patients with breast (8), colorectal (9), or gastric ( 10) carcinomas and urinary neopterin concentrations above normal have been reported ( Table 2).…”

Neoadjuvant combination therapy with trastuzumab in a breast cancer patient with synchronous rectal carcinoma: a case report and biomarker study

“…In another report, slightly elevated serum neopterin concentrations were observed in breast cancer survivors with chronic fatigue [47]. A rise of neopterin concentrations has been documented in breast cancer patients treated with doxorubicin/paclitaxel combination chemotherapy [48].…”

Urinary Neopterin in Patients Treated with Gefitinib

“…Gefitinib seems to be more effective in Asian populations, and immune activation induced by the treatment with this drug has been reported in Asian patients (5). An increase of neopterin production has been documented in cancer patients after systemic administration of different cytokines (9) or with the combination of paclitaxel and doxorubicin (10). On the other hand, reduction of the tumor burden may result in lower neopterin (16).…”

“…Increased neopterin is a prognostic factor associated with inferior survival. Moreover, changes in neopterin concentrations have been observed in body fluids of cancer patients treated with cytokines or cytotoxic agents (9,10). Measurement of intestinal permeability is used to study the disorders of the barrier function of the gut mucosa in benign disorders, including inflammatory bowel disease and gluten enteropathy.…”