CAPILLARY PROTEIN LEAK SYNDROME APPEARS TO EXPLAIN FLUID RETENTION INCANCER-PATIENTS WHO RECEIVE DOCETAXEL TREATMENT

Purpose: The aim of our study was to elucidate whether the fluid reten tion syndrome induced by docetaxel is caused by capillary protein leak age or by other mechanisms. Patients and Methods: Twenty-four patients with advanced or metastatic non-small-cell lung cancer (NSCLC; 23 pat ients) or metastatic head and neck cancer (one patient) were included on this prospective, nonrandomized trial. Docetaxel 100 mg/m(2) was ad ministered every 3 weeks with 5 days of dexamethasone prophylaxis to a void hypersensitivity reactions and edema formation. Transcapillary fo rces, ie, colloid osmotic pressure of plasma (COPpl) and interstitial fluid (COPint) and interstitial hydrostatic pressure (P-int), were mea sured before the start of treatment and after total docetaxel doses of 200 and 500 mg/m(2) by means of the well-documented wick and wick-in- needle methods. Body weight, degree of edema, blood pressure, and hear t rare and hemoglobin, hematocrit, albumin, and total protein values w ere registered in parallel. Results: After a total docetaxel dose of 2 00 mg/m(2), COPpl, COPint, and hemoglobin, hematocrit, albumin, and to tal protein values had decreased significantly; P-int and body weight were unchanged; and only mild edema was observed. These findings sugge st a plasma volume increase followed by enhanced fluid filtration to t he interstitium. After a cumulative docetaxel dose of 500 mg/m(2), the COPpl continued to decrease significantly, but COPint remained unchan ged despite a significant increase in mean body weight and edema forma tion. These observations support the theory of a capillary protein lea kage. Conclusion: Docetaxel appears to induce an initial enhancement o f fluid filtration followed by a capillary protein leakage that leads to edema formation. (C) 1998 by American Society of Clinical Oncology.