Inflammation May Predict Chemotherapy-Induced Weakness in Older Women With Breast Cancer

High levels of inflammation, as well as high BMI and later-stage disease, may be predictors of weakness after chemotherapy treatment in older patients with breast cancer, which may hold potential in guiding treatment decisions.

Older patients with breast cancer who have high levels of inflammation are three times more likely to experience weakness after adjuvant chemotherapy, according to recent study results.

“Our findings suggest that older patients with breast cancer with high IL-6 and (C-reactive protein), and especially those with both markers elevated, are vulnerable to experiencing a decline in physiologic reserve with chemotherapy treatment, even if they appear to be robust or clinically fit,” the researchers wrote in the study published in the Journal of Clinical Oncology.

Researchers evaluated inflammatory biomarkers interleukin-6 and C-reactive protein prior to treatment with chemotherapy in 295 older women with breast cancer (65 years or older). These two biomarkers were selected because previous research into interleukin-6 and C-reactive protein have demonstrated their relationship with functional status, heart health and mortality, according to the study’s introduction.

Frailty was also assessed before and after chemotherapy with scores categorizing patients as robust (clinically fit), prefrail (decline in frailty status) or frail.

The results from this study demonstrated that 76 patients (26%) experienced weakness from chemotherapy. Among those patients, 65.8% had high levels of interleukin-6 and 63.2% had high levels of C-reactive protein.

After researchers took clinical characteristics into consideration, patients with high levels of both interleukin-6 and C-reactive protein were three times more likely to experience weakness because of chemotherapy compared to those with low levels.

Additionally, patients with higher BMI (indicating a patient with overweight or obesity) and more comorbidities had significantly higher odds of experiencing weakness compared to those with a low BMI and fewer comorbidities. Patients with stage 2 or 3 disease also had a higher risk of weakness compared to those with stage 1.

The study authors noted that these results highlight three important clinical implications. The first being that older patients with breast cancer who have high levels of inflammation biomarkers are likely to experience weakness from chemotherapy.

Additionally, inflammation may be targetable with interventions to prevent or mitigate chemotherapy-induced decline. Interventions such as exercise and diet changes, which have been shown to be beneficial in breast cancer survivors, may improve fitness and functional recovery after chemotherapy.

“Further work is needed to better understand the mechanism of these anti-inflammatory strategies to pave the way for future novel interventions to prevent, treat and, ideally, reverse the unintended aging consequences of chemotherapy,” they continued.

Finally, inflammation and other mechanisms associated with aging may be predictors on the effect chemotherapy will have on a person’s weakness levels.

“Our findings provide novel insight into the biologic processes of aging that predict tolerance of cancer treatment and form a foundation for further work to appraise inflammatory biomarkers as a novel tool to guide treatment decisions,” the study authors concluded.

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