Journal of Clinical Oncology, Vol 16, 3426-3432, Copyright © 1998 by American Society of Clinical Oncology
Capillary protein leak syndrome appears to explain fluid retention in cancer patients who receive docetaxel treatment
KA Semb, S Aamdal and P Oian
Department of Oncology, The Norwegian Radium Hospital, Oslo. kasemb@online.no
PURPOSE: The aim of our study was to elucidate whether the fluid retention
syndrome induced by docetaxel is caused by capillary protein leakage or by
other mechanisms. PATIENTS AND METHODS: Twenty-four patients with advanced
or metastatic non-small-cell lung cancer (NSCLC; 23 patients) or metastatic
head and neck cancer (one patient) were included on this prospective,
nonrandomized trial. Docetaxel 100 mg/m2 was administered every 3 weeks
with 5 days of dexamethasone prophylaxis to avoid hypersensitivity
reactions and edema formation. Transcapillary forces, ie, colloid osmotic
pressure of plasma (COPpl) and interstitial fluid (COPint) and interstitial
hydrostatic pressure (Pint), were measured before the start of treatment
and after total docetaxel doses of 200 and 500 mg/m2 by means of the
well-documented wick and wick-in- needle methods. Body weight, degree of
edema, blood pressure, and heart rate and hemoglobin, hematocrit, albumin,
and total protein values were registered in parallel. RESULTS: After a
total docetaxel dose of 200 mg/m2, COPpl, COPint, and hemoglobin,
hematocrit, albumin, and total protein values had decreased significantly;
Pint and body weight were unchanged; and only mild edema was observed.
These findings suggest a plasma volume increase followed by enhanced fluid
filtration to the interstitium. After a cumulative docetaxel dose of 500
mg/m2, the COPpl continued to decrease significantly, but COPint remained
unchanged despite a significant increase in mean body weight and edema
formation. These observations support the theory of a capillary protein
leakage. CONCLUSION: Docetaxel appears to induce an initial enhancement of
fluid filtration followed by a capillary protein leakage that leads to
edema formation.
