Anna Rose Johnson, Melisa D. Granoff, Bernard T. Lee, Timothy P. Padera, Echoe M. Bouta, and Dhruv Singhal. Ann Plast Surg 2019;82: S173–S178

Main findings

• Watch this space the results of this research and hopefully future research will provide us with ways of targeting perhaps high risk individuals in our lymphoedema surveillance programs.
• Consecutive patients with unilateral node-positive breast cancer undergoing preoperative ICG lymphangiography of the ipsilateral extremity from January 2018 to September 2018 were identified.
• Patients who had undergone prior ALND or radiation of the operative extremity were excluded from analysis.
• Twenty-nine patients with unilateral breast cancer who underwent preoperative ICG lymphangiography were initially identified. Of these, 19 patients received taxane-based NAC and 10 patients did not receive any neoadjuvant chemotherapy (NAC). Patients in each group were well matched with respect to age, BMI, ethnicity, race, and baseline objective measurements demonstrating no evidence of LE at the time of lymphangiography.
• There was appreciable variability observed in the contractility rates between the 4 different taxane-based NAC regimens.
• The mean contractility rate for the most common chemotherapy regimen, adriamycin cyclophosphamide-paclitaxel, was 0.76 c/m (n = 14). The patient cohort who underwent adriamycin and cyclophosphamide-paclitaxel, Herceptin, and pertuzumab had the highest contractility rate (2.08 c/m) (n = 1). The mean contractility for patients undergoing adriamycin, cyclophosphamide, paclitaxel, and Herceptin was 0.33 c/m (n = 3).
• In this pilot study, we did not identify a statistically significant difference in the lymphatic contractility rates between patients who received taxane-based NAC and those who did not. Upon subgroup analysis, those patients who reported symptoms of taxane-based neuropathy demonstrated a statistically significant lower contractility rate compared to asymptomatic patients and patients who did not receive any NAC. Moreover, there was significant heterogeneity within the contractility values of patients receiving different taxane-based NAC regimens.
• A larger sample size is needed in order to better evaluate the effect of taxanes, and different taxane combination regimens, on lymphatic contractility. Additionally, follow-up data are needed to determine if there is any correlation between contractility values and lymphedema development.
• Their subgroup analysis demonstrated a statistically significant reduction in lymphatic contractility in those patients reporting taxane-based neuropathy. This finding warrants further discussion on how taxanes may influence lymphatic contractility. Although the mechanism of taxane-mediated neuropathy has been well studied, the effect of taxanes on lymphatic contractility has not.
• The authors suggest if taxanes do indeed contribute to systemic lymphatic dysfunction, then it could be contended that they predispose cancer patients to postoperative lymphedema if administered in the neoadjuvant or adjuvant setting.
• Limitations include the lymphangiogram videos analyzed are taken as part of the standard of care and are limited to recordings of the dorsum of the hand of the operative extremity.
• Additionally, contractility of lymphatics of other areas of the arm could not be quantified.
• At this time, imaging of the contralateral extremity is not part of the standard of care, hindering our ability to compare lymphatic contractility values of both patient extremities. Follow-up data and repeat lymphangiograms of these patients would be necessary to correlate contractility rates to lymphatic disease development in this patient cohort.
• Additional study into the mechanism of action of taxanes and its interplay with the lymphatics is clearly needed and will enrich our understanding of a fundamental treatment component of breast cancer therapy.