Unwanted side effect found with certain combination cancer treatment

Chemotherapy drug associated with lung inflammation in breast cancer patients

Treating cancer patients with radiation plus chemotherapy is often an effective strategy, but researchers at Massachusetts General Hospital (MGH) have found that certain combinations may increase the incidence of an inflammatory condition called radiation pneumonitis in breast cancer patients. Published in the December 5 Journal of the National Cancer Institute, the results suggest that doctors use extra caution when administering radiation therapy with the chemotherapy drug paclitaxel.

"The bottom line is that these treatments can cause this potentially serious form of lung inflammation, so we need to be alert and wary of it," says senior investigator Simon Powell, MD, PhD, a radiation oncologist at MGH.

Alphonse Taghian MD, PhD, lead author of the study, and his colleagues found that, when breast cancer patients were given chemotherapy that included paclitaxel in addition to radiation therapy directed at the breast-chest wall, radiation pneumonitis developed in six of the 41 patients, or 14.6 percent. For patients treated with chemotherapy drugs that did not include paclitaxel, the rate of lung inflammation was only 1.1 percent.

"There's some controversy over the effectiveness of paclitaxel in addition to standard chemotherapy," says Powell. "Now we're adding this additional information about using the drug in conjunction with radiation therapy." Taghian explains that radiation pneumonitis is an acute inflammation of the lung, and symptoms include shortness of breath, cough and low-grade fever. He stresses that the success rate of treatment for pneumonitis is almost 100 percent, though.

"This complication should not make the patient refuse paclitaxel. It can be delivered safely in combination with radiation, but we need to use extra caution in the placement of the radiation beams," says Taghian, also of the MGH radiation oncology department.

Doctors and patients who are not aware of this potential side effect will benefit from the new information. "This is a miniature alert on something doctors don't always look for," says Powell. "We had to look carefully to spot the occurrence of this condition; now we can alert others to do the same."

Other MGH researchers involved in this study include Sherif Assaad, MD, Andrzej Niemierko, PhD, Irene Kuter, MD, Jerry Younger, MD, Robin Schoenthaler, MD, and Maria Roche, MS, RNCS. Support for this study was provided in part by Public Health Service grants from the National Institutes of Health.

The Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $300 million and major research centers in AIDS, the neurosciences, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Women's Hospital to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.