Pharmacotherapy Agents in Lymphedema Treatment: A Systematic Review

Antonio J Forte, Daniel Boczar, Maria T Huayllani, Xiaona Lu, Sarah A McLaughlin, Antonio J Forte, Daniel Boczar, Maria T Huayllani, Xiaona Lu, Sarah A McLaughlin

Abstract

It is estimated that one in every six patients undergoing solid cancer treatment will develop secondary lymphedema. We conducted a systematic review of publications assessing the potential use of pharmacotherapy agents in lymphedema treatment. The search was conducted on PubMed and eligibility criteria excluded papers that investigated other therapies or focused on primary lymphedema. From 285 potential papers found in the literature, seven studies fulfilled the eligibility criteria. Different types of therapies were proposed, but all of them interfered with inflammation in the lymphedema tissue. Interestingly, the majority of publications were clinical, and three authors conducted randomized, placebo-controlled, double-blinded clinical studies. Promising results were observed for the oral administration of ketoprofen or selenium and topical tacrolimus. Pharmacotherapy agents were successfully described in lymphedema treatment in clinical and experimental studies. The benefits of delivering ketoprofen, selenium, or tacrolimus in lymphedema were noticed, and these therapies were easily delivered and well-tolerated.

Keywords: breast cancer lymphedema; individualized medicine; inflammation; lower extremity; lymphedema; pharmacologic treatment; pharmacotherapy; plastic surgery; targeted therapy; upper extremity.

Conflict of interest statement

This study was supported by the Mayo Clinic Center of Individualized Medicine and Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. *No other disclosures for all authors

Copyright © 2019, Forte et al.

Figures

Figure 1. PRISMA Flow Chart of Included…
Figure 1. PRISMA Flow Chart of Included Studies in the Systematic Review of the Literature.
PRISMA: Preferred Reporting Items for Systematic reviews and Meta-Analyses

References

    1. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Cancer. 2010;116:5138–5149.
    1. Pathological steps of cancer-related lymphedema: histological changes in the collecting lymphatic vessels after lymphadenectomy. Mihara M, Hara H, Hayashi Y, et al. PLoS One. 2012;7:41126.
    1. Risk factors for lymphedema in a prospective breast cancer survivorship study: the pathways study. Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, Kushi LH. Arch Surg. 2010;145:1055–1063.
    1. Cellular and molecular mechanisms of fibrosis. Wynn TA. J Pathol. 2008;214:199–210.
    1. Experimental assessment of pro-lymphangiogenic growth factors in the treatment of post-surgical lymphedema following lymphadenectomy. Baker A, Kim H, Semple JL, Dumont D, Shoichet M, Tobbia D, Johnston M. Breast Cancer Res. 2010;12:70.
    1. Lymphangiogenesis and lymphangiogenic growth factors. Hartiala P, Saarikko AM. J Reconstr Microsurg. 2016;32:10–15.
    1. Sterile inflammation after lymph node transfer improves lymphatic function and regeneration. Joseph WJ, Aschen S, Ghanta S, et al. Plast Reconstr Surg. 2014;134:60–68.
    1. A trial of intra-lymphatic cyclophosphamide in patients with arm lymphoedema due to metastatic breast carcinoma. Kitchen G, Garrett MJ. Clin Radiol. 1971;22:379–381.
    1. Treatment of secondary lymphedema of the arm with physical decongestive therapy and sodium selenite: a review. Kasseroller RG, Schrauzer GN. . Am J Ther. 2000;7:273–279.
    1. Selenium in the treatment of radiation-associated secondary lymphedema. Micke O, Bruns F, Mucke R, et al. . Int J Radiat Oncol Biol Phys. 2003;56:40–49.
    1. Reduction of postoperative lymphedema after oral tumor surgery with sodium selenite. Zimmermann T, Leonhardt H, Kersting S, Albrecht S, Range U, Eckelt U. Biol Trace Elem Res. 2005;106:193–203.
    1. Anti-inflammatory pharmacotherapy with ketoprofen ameliorates experimental lymphatic vascular insufficiency in mice. Nakamura K, Radhakrishnan K, Wong YM, Rockson SG. PloS One. 2009;4:8380.
    1. Topical tacrolimus for the treatment of secondary lymphedema. Gardenier JC, Kataru RP, Hespe GE, et al. Nat Commun. 2017;8:14345.
    1. Pilot studies demonstrate the potential benefits of antiinflammatory therapy in human lymphedema. Rockson SG, Tian W, Jiang X, et al. JCI Insight. 2018;3:0.
    1. Tumor necrosis factor mediation of NSAID-induced gastric damage: role of leukocyte adherence. Appleyard CB, McCafferty DM, Tigley AW, Swain MG, Wallace JL. Am J Physiol. 1996;270:42–48.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir