Breast Cancer Drug Triggers Lung Disease Taxol More Likely Than Other Drugs to Cause Problem By Michael Smith , MD Dec. 4, 2001 Women with early-stage breast cancer often receive chemotherapy. But a new study shows that one chemotherapy drug in particular appears to increase the risk of lung inflammation, and researchers suggest using it with caution. Taxol is a relatively new drug in the world of breast cancer treatment. Some studies have suggested that women with cancer that has spread to their lymph nodes might do better with Taxol, but this has not yet been proven. Taxol is often used along with radiation treatments since it's thought the drug might enhance the radiation's effects. Researchers have now found, however, that the combination may cause more problems than it solves. Lead researcher Alphonse G. Taghlan, MD, and colleagues looked at 41 women who'd received both chemotherapy, including Taxol, and radiation. They wanted to see if a lung problem -- called radiation pneumonitis -- was more common with Taxol. Radiation pneumonitis is lung inflammation that occurs from radiation. It develops about eight weeks after completing a course of radiation. Chemotherapy increases the chance of having this problem. Symptoms include fever, difficulty breathing, and a severe, dry cough. Many people improve gradually over a few weeks. But when the disease is severe, strong anti-inflammatory steroids are often used, with uncertain benefit. Typically, the affected area of the lung scars and shrinks with time, and X-ray shows loss of usable lung space. Radiation pneumonitis is normally rare, but the researchers found that it was much more common in women who received Taxol. The results are published in the Dec. 5 issue of the Journal of the National Cancer Institute. Just 1% of women who'd received radiation and chemotherapy without Taxol developed radiation pneumonitis, compared with nearly 15% of those given Taxol. The researchers say this finding is highly significant and suggest that Taxol be used with caution, especially since Taxol has not been shown to have any clear benefit. Future research will help women with breast cancer and their doctors determine the real risk of Taxol. In the meantime, you can use these findings as an opportunity to discuss the available treatment options with your doctor. Thanks to WebMD Medical News J Natl Cancer Inst 2001 Dec 5;93(23):1806-1811 Risk of Pneumonitis in Breast Cancer Patients Treated With Radiation Therapy and Combination Chemotherapy With Paclitaxel. Taghian AG, Assaad SI, Niemierko A, Kuter I, Younger J, Schoenthaler R, Roche M, Powell SN. A. G. Taghian, S. I. Assaad, R. Schoenthaler, S. N. Powell (Department of Radiation Oncology), A. Niemierko (Departments of Radiation Oncology and Biostatistics), I. Kuter, J. Younger, M. Roche (Department of Medical Oncology), Massachusetts General Hospital, Harvard Medical School, Boston, MA. BACKGROUND: Some chemotherapy (CT) drugs, including taxanes, may enhance the effectiveness of radiation therapy (RT). However, combining these therapies may increase the incidence of radiation pneumonitis, a lung inflammation. In a retrospective cohort study, we evaluated the incidence of radiation pneumonitis in breast cancer patients treated with RT and standard adjuvant CT by use of doxorubicin (Adriamycin) and cyclophosphamide, with and without paclitaxel. METHODS: Forty-one patients with breast cancer were treated with RT and adjuvant CT, including paclitaxel. Paclitaxel and RT (to breast- chest wall in all and lymph nodes in some) were delivered sequentially in 20 patients and concurrently in 21 patients. Paclitaxel was given weekly in some patients and every 3 weeks in other patients. The incidence of radiation pneumonitis was compared with that among patients in our database whose treatments did not include paclitaxel (n = 1286). The percentage of the lung volume irradiated was estimated. The Cox proportional hazards model was used to find covariates that may be associated with the observed outcomes. All P values were two-sided. RESULTS: Radiation pneumonitis developed in six of the 41 patients. Three patients received paclitaxel concurrently with RT, and three received it sequentially (P =.95). The mean percentage of lung volume irradiated was 20% in patients who developed radiation pneumonitis and 22% in those who did not (P =.6). For patients treated with CT including paclitaxel, the crude rate of developing radiation pneumonitis was 14.6% (95% confidence interval [CI] = 5.6% to 29.2%). For patients treated with CT without paclitaxel, the crude rate of pneumonitis was 1.1% (95% CI = 0.2% to 2.3%). The difference between the crude rates with or without paclitaxel is highly statistically significant (P<.0001). The mean time to develop radiation pneumonitis in patients treated concurrently with RT and paclitaxel was statistically significantly shorter in patients receiving paclitaxel weekly than in those receiving it every 3 weeks (P =.002). CONCLUSIONS: The use of paclitaxel and RT in the primary treatment of breast cancer should be undertaken with caution. Clinical trials with the use of combination CT, including paclitaxel plus RT, whether concurrent or sequential, must evaluate carefully the incidence of radiation pneumonitis. PMID: 11734597 [PubMed - as supplied by publisher] Intl J of Rad Oncology, Biology, Physics, 1/02 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. 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