Author: Laura Cowen
medwireNews: Clinically fit older women with early breast cancer are more likely to experience a chemotherapy-induced decline in frailty status if they have high pretreatment levels of interleukin (IL)-6 and C-reactive protein (CRP), research shows.
“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,” write Mina Sedrak (City of Hope National Medical Center, Duarte, California, USA) and co-authors in the Journal of Clinical Oncology.
The prospective study included 295 women (median age 69 years) with stage I–III breast cancer who were considered clinically robust according to the Deficit Accumulation Index (DAI), which evaluates health status according to deficits in physical and instrumental activities of daily living, psychosocial status, nutrition, frequency of falls, number of medications, comorbidities, social support, and laboratory data.
Of these, 74.2% maintained their DAI robust status following chemotherapy, whereas 23.4% moved down into the prefrail category and 2.4% down to the frail category.
Among the 76 women who experienced chemotherapy-induced decline in frailty status, 65.8% had a high IL-6 level (above the median of 2.5 pg/mL) at baseline, 63.2% had high CRP (>3.5 mg/L), and 46.1% had above-median levels of both inflammatory markers. By comparison, both prechemotherapy IL-6 and CRP were elevated in 25.6% of participants who remained clinically fit postchemotherapy.
After accounting for age, race/ethnicity, education, BMI, cancer stage and treatment, medication use, and comorbidity, the researchers found that people with high IL-6 at baseline were a significant 2.42 times more likely to have a decline in frailty status than those with low IL-6.
Similarly, women with high prechemotherapy CRP levels had a significant 1.88-fold increased likelihood of becoming more frail than those with low CRP levels.
When the two markers were assessed together the risk for decline in frailty status was a significant 3.52 times higher in the participants with elevated IL-6 and CRP relative to those with low levels of both markers.
Sedrak and team suggest that “biologic measures of inflammation may facilitate individualized risk assessment of chemotherapy-induced decline in frailty status at the time of diagnosis and before treatment initiation.”
Furthermore, “inflammation may be a targetable biological pathway that can be leveraged to prevent and mitigate chemotherapy-induced clinical decline,” they write.
However, the authors caution that further work is needed to establish the mechanism for how anti-inflammatory strategies might “pave the way for future novel interventions to prevent, treat, and, ideally, reverse the unintended aging consequences of chemotherapy.”
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