now they are moving in on how/why of weight gain during chemotherapy 4 breast cancere

Lani · 06-11-2010, 01:45 AM

Breast Cancer Res Treat. 2010 Jun 10. [Epub ahead of print]
Circulating sphingosine-1-phosphate inversely correlates with chemotherapy-induced weight gain during early breast cancer.
Pchejetski D, Nunes J, Sauer L, Sidhu J, Sharma A, Keun HC, Waxman J, Stebbing J.

Department of Surgery and Cancer, Imperial College, London, UK, d.pshezhetskiy@imperial.ac.uk.
Abstract
Weight gain in women receiving chemotherapy for breast cancer is associated with a higher risk of recurrence. Using metabonomic profiling, we recently reported that plasma lactate and alanine were prognostic for weight gain in individuals with breast cancer receiving chemotherapy. The role of lipid second messengers has not been studied. We assessed serum levels of sphingosine-1-phosphate (S1P), a known secreted lipid second messenger with a role in cell growth, in sequential samples from post-menopausal women receiving standard chemotherapy for early breast cancer and correlated these with body mass measurements and metabonomic profiling. While serum S1P levels prior to treatment did not correlate with body weight changes or circulating alanine and lactate, S1P levels measured during therapy were inversely correlated with weight gain (P = 0.04), but not weight loss (P = 0.74) or no change in weight (P = 0.5), suggesting a role of dynamic circulating S1P in adipocyte growth. These data provide evidence for an association between serum S1P and weight gain during chemotherapy cycles in women with breast cancer. Lipid second messengers have a role in chemotherapy-induced weight gain in breast cancer.

PMID: 20535545

sarah · 06-11-2010, 02:03 AM

Lani you are always a source of great info, although some of I have trouble understanding!
Thanks for this. Personally I gained 15 lbs during chemo and have not lost it. I assumed it was because my metabolism shut down totally, I was constantly tired. Had Taxol and Herceptin every week for 6 months for a recurrence. Before the chemo I was 125 lbs for 5'6" now I'm 140 and I've changed up several sizes. I've never had to diet before it my life and when I try, it doesn't seem to do any good. Most of my life I was between 108 lbs and 118 lbs, only putting on the extra 7 slowly after 45 years of age. Now I'm 64. I'll see my oncologist shortly and show this to him.
health and happiness
sarah

Hopeful · 06-11-2010, 06:33 AM

This study is interesting, but omits one very important factor: the role of the steriods given as support drugs during chemotherapy on metabolism and weight gain. To say that this is "chemotherapy-induced weight gain" leaves a rather large elephant in the room, IMO.

Hopeful

freyja · 06-11-2010, 08:10 AM

I agree. I think the steroids have even more to do with it. I've heard from other people with other cancers that the same thing happened to them, and the weight seems to be just as stubborn to come off for everyone, too. Can they study to find a way to lose the weight?!

fullofbeans · 06-11-2010, 11:47 AM

and what about the psychological effect of chemo, I know that the first time I was dx and then on treatment I developped a bad relationship with food and started to eat out of comfort and worries..and it was an habit that took 1.5 year after treatment to check off.

1rarebird · 06-11-2010, 03:05 PM

This is very interesting, but I think there other explanations for chemo-related weight gain. I added 25 lbs during my Taxotere/Carboplatin months. I had great fatigue and edema in my legs. The T/C worked on my bone marrow, accounting for the fatigue. And my doctor told me the edema was an unfortunate consequence of the Taxotere. I am happy to report that I have now lost almost all of that 25 lbs once the chemo was over and edema tapered off. So I think that lipid concentration increases don't tell the full story here. I could be wrong--many times I am.

bird

Jackie07 · 06-12-2010, 12:57 AM

I gained weight during my chemo also. But I gain weight every time I recover from a serious illness/an operation. I finally realized that I'd been underweight most of my life. So now I eat whenever I feel like and eat whatever I feel like. I know I will go work out (walking) if I 'feel' there's extra fat somewhere in my body. Since I've never been overweight in my life, my concern is more on the underweight side. And I really need to be careful. Everytime I was under 120 lb, I eventually found out there's a serious illness involved. No kidding! It happened everytime.

swimangel72 · 06-12-2010, 07:18 AM

Chemo makes a person so sick and tired, no wonder we gain weight - we're lucky to get up and shower and get dressed forgetabout any kind of serious exercise! Even now, two years after my tx's, my level of exercise intensity has dropped off - but it all started when I hit menopause - the lack of estrogen in my body started the upward weight climb which I was able to keep a little bit in check by increasing my exercise - but now, I feel I need to starve myself and workout like a maniac just to lose two pounds, sigh..........

hutchibk · 06-12-2010, 08:40 AM

Exactly, Kathy. It's a beast created by feeling low (energy and emotion), being sedentary, menopause, eating more to curb nausea, steroids, and then probably exacerbated by the "lipid second messengers" ~ or maybe the other way around... but I have a hard time believing the S1P would be the only culprit. Researchers need to open all their eyes sometimes.

AlaskaAngel · 06-12-2010, 12:13 PM

Steroids are known to be a weight gain factor for many. What hasn't been recognized is the intensity or degree of the problem the use of them promotes, that then can feed into recurrence by weight gain that is harder to manage.

The vast majority of breast cancer patients are older and menopausal, and when steroid use is piled on top of that, it isn't just a matter of conscientious exercise and dieting for this group. It includes more muscle loss, and greater muscle fatigue.

I really think they are wasting time and lives by not actively seeking to identify some kind of minimal support for this physiologic permanent change in our metabolism, such as carefully investigating whether or not some very low dose of a diabetic support drug ALONG WITH proper conscientious diet and exercise would help us.

But I think that first they need to admit that the problem is genuine. From what I can see on a personal basis, the problem is that one has to stay on a zero tolerance diet/exercise plan, which leaves NO room for any deviation at all -- no "time off" for any reason, whether for handling emergencies, dealing with economic factors, feeling ill, etc. And eventually we lose ground because real life won't let us.

Medical providers see a lot of people who truly don't make the effort in the first place. But the truth is that this problem is happening to a lot of the people in the group who do make a consicentious effort. We got here with the steroids and treatment and we need help with the result.

I have to add here that in my opinion, in effect they are patting themselves on the back for "saving lives" but they aren't realizing AND taking responsibility for the role the steroids can play in setting a number of us up to recur.

A.A.

vlcarr · 06-12-2010, 10:51 PM

I've also gained weight but not sure how much yet. I've never owned a scale and will not weigh again until I get my last herceptin on the 24th of this month. When I was on the tykerb/herceptin trial I lost weight. During chemo I pretty much maintained my weight. However, once chemo was over and while on radiation is when I noticed my weight going back up.

The other odd thing I've noticed is how much I crave sweets. I've never in my whole life leaned toward sweets, not the carbs/chips, etc where a different story. So, not only did I go through all the treatment, I also went into chemopause and it seems like every time I turn around I crave something sweet!!!

I've had several surgeries in my life, including one that confined me to a wheelchair for 3 months and always I've lost weight.

As someone who struggled with being too heavy during their teenage years and as a young adult, I find this very frustrating. I kept thinking when I get back to my normal activity it will get better.....sigh.

The sweet cravings seem to be getting somewhat better but I can definitely tell the weight is creeping upward.

On a positive note, my hair is growing back pretty fast

Maybe it's the sweet stuff I've been eating-lol.

hutchibk · 06-13-2010, 10:18 AM

VL ~ Me Too!! I never had a sweet tooth before cancer and chemo, most of my life I basically had an aversion to most of anything that was too sweet (and most anything that was sweet was too sweet for me), and I didn't lean towards simple carbs at all. After chemo, I also started to crave sweets, treats, desserts, etc. Luckily, I am pretty good at talking myself out of it, but it was one of the first things I noticed.

jml · 06-13-2010, 04:12 PM

Rapid weight gain, chronic fatigue & crazy cravings for any/all sweets, crazy blood sugar swings/crashes are among the reason I finally saw an endocrinologist - assuming I was hypothryoid after a year of Taxol/Herceptin.
Instead, they did a Glucose Challenge & I was diagnosed with INSULIN RESISTANCE - Not diabetic. Not pre-diabetic - Insulin resistance as a result of exposure to chronic doses of pre-med steroids. The doc said that now that we're seeing more long term survivors, having been exposed to larger, longer doses of therapies, this is one secondary issues that they're discovering.
The endocrinologist put me on Glucophage/metformin at that time, explaining that most rn's/docs, etc. won't understand that I'm not diabetic & I will likely have to go through an explanation each time I have a procedure or meet new docs.
He was right - this past week of Novalis and the Chemo embo I had to explain to everyone why I take the Glucophage, and no, you don't need to check my blood sugar.Actually, I ususally give them the explanation, but let them take my blood sugar anyway because they look so confused.
It's been an pretty interesting ride.
I've never been re-evaluated by an endocrinologist, instead I choose to stay on the glucophage because of the studies showing the benefits with MBC. My oncs don't argue with me about it. In fact, they support my continuing on it.
Ironically, it is because I have been on Glugophage that I was disqualified from screening for a TDM1 trial last April. Can't win for losing, it seems.
Just one thing to remember, whenever having CT's, I have to d/c using it for 36hrs before, then can't resume until 48hours after.
Anyone else out there already on Metoformin?

AlaskaAngel · 06-13-2010, 11:30 PM

Hi jml

Earlier this year, with a referral from my PCP as well as documented visits with the Seattle cancer center registered dietitian, I approached various endocrinologists for an appointment about this problem. I was repeatedly told that they refused to see me unless I had been diagnosed with diabetes or a thyroid problem. All of these endocrinologists specifically listed that they specialized in metabolism issues. Finally I found one endocrinologist who was willing to actually see me, who did, and who then had labs drawn to be able to see what was going on. I suggested using a low dose of metformin, and the endocrinologist is evaluating my progress and considering my request. I am scheduled to see the endocrinologist again to discuss it.

Also, although admittedly the following study was funded through a grant provided by a manufacturer of metformin, the results are interesting to consider:

http://www.oncolink.org/news/index.c...detail&ID=1117

Rich66 · 06-14-2010, 02:18 AM

JML,
Why do you d/c metformin prior to CT? I thought it was only a potential confounder with respect to PET.

AlaskaAngel · 06-19-2010, 08:36 AM

Jessica, I read your other thread and this one and from this one it sounds like you were having major weight gain, but from the other thread it sounds like that changed for you to major weight loss, with your mom there to help feed you. Did the weight loss happen just since you started the metformin, or do you think the weight loss is related to starting the other therapy as well? I am wondering too how your endocrinologist is managing these kinds of questions for you, or what he/she thinks about the weight gain/loss and the metformin?

Trying to sort out insulin resistance too,

AlaskaAngel

jml · 06-19-2010, 10:04 AM

Rich-I've never asked for specific details, but I'm always reminded by the scan schedulers to d/c the metformin the day (~36hrs) before scans and then not re-start until 48hours after. Apparently the metformin is really hard on the liver and kidneys, as is the contrast, so in combo it's probably just a little too much.
AA-I was evaluated by an endocrinologist 7 years ago, after the 1st year of my treatment.it was after the 1st year that I was having the problems with fatigue, blood sugar swings and weight gain (18 pounds in 6 weeks). A glucose challenge confirmed I was insulin resistant, I started the metformin and all the symptoms resolved. since then, my weight normalized, my blood sugar levels stabilized and everything has been fine. I have not been re-evaluated by an endocrinologist since, but as I mentioned my onc knows I'm on metformin and has approved my continued use.
In the past 4 months, since starting Ixempra, my weight has dropped significantly because my appetite & energy are so compromised. Ixempra's really tough stuff - I'm on my 5th cycle, and thank God it's working because my quality of life on this drug is really limited. I'm not able to work anymore and am so thankful my Mom's here to help me.
Ask your endo to do a glucose challenge test- it's pretty simple - you have to fast, then at different time points over a few hours you drink a high glucose drink and they take blood samples to see how long it takes your body to absorb it.
Wishing you best of luck sorting all this out.

DiDi70 · 07-12-2010, 09:44 AM

I have just finished chemotherapy and have now developed an outrageous sweet tooth. It's a problem that I have never had prior to chemo. I found that I gained water weight after each chemo treatment; on average 7 lbs, which came off each time within 2 weeks. I was put into premature menopause at the age of 39 due to chemo and I definitely feel that my body is sluggish since that occurred. I am going to try a detox and then a vegetarian diet for a while to see how things go and I will eliminate all white food such as pasta and sugar.

Regarding Metformin: My Cancer Clinic at the London Regional Cancer Centre is now embarking on a study of Metformin use in people undergoing chemotherapy and also looking at the sugar "feeding" cancer theory. I will post when I know more after my visit in two weeks.

Have a good day,

DiDi

SuePen · 07-17-2010, 05:22 AM

I had TCH and have lost 22lbs. I'm now 18 weeks post chemo. I thought maybe it was because I stopped taking HRT when diagnosed.

Chelee · 07-18-2010, 02:12 AM

Like "SuePen"...I actually lost weight when I started TCH. I lost 35 lbs...I couldn't eat. Food was horrible...I thought I'd gain it all back when I finished the Taxotere & Carb but I didn't? (One of those things that make you go hummmm?)

Chelee