Crowley Fionnuala, Brown Stav, Gallagher Emily J, Dayan Joseph H
Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Plastic and Reconstructive Surgery Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Front Oncol. 2024 Apr 18;14:1392375. doi: 10.3389/fonc.2024.1392375. eCollection 2024.
Lymphedema is a major public health issue for many women undergoing breast cancer treatment. Although weight loss has been reported to be beneficial in the treatment of lymphedema, no studies to date have examined the use of GLP-1RAs for the treatment of secondary lymphedema. This case report describes a patient who experienced significant resolution of her breast cancer-related lymphedema after initiation of a GLP-1RA for weight loss.
MAIN SYMPTOMS AND/OR IMPORTANT CLINICAL FINDINGS: Nine months postoperatively the patient developed arm swelling and disability. While on adjuvant chemo and hormonal therapy, her weight increased dramatically and peaked 4 years later. Corresponding to her weight gain was significant worsening of her symptoms.
Due to adjuvant cancer-related weight gain and inability to lose weight with diet and exercise, she was referred for evaluation and diagnosed with lymphedema. The patient started treatment with a Glucagon-like peptide 1 receptor agonist and lost 24% of her body weight over the next 13 months. The improvement in her lymphedema mirrored her weight loss. Her limb volume difference dropped from 10.3% down to 3.4% and she no longer required a compression garment. Her imaging demonstrated return of lymphatic pumping and she experienced a significant improvement in quality of life, assessed by a validated lymphedema-specific patient reported outcome (PROM). She remains on hormonal therapy, no longer needs compression and is back to regular exercise without impairment.
GLP-1 RAs provide a potential medical option for many patients struggling with weight gain and lymphedema. We have observed by all objective measures a significant reduction in lymphedema and the elimination of compression in the case presented as a direct result of GLP-1 RA. This may also reduce a patient's BMI to the point where they become a good candidate for lymphovenous bypass or vascularized lymph node transplant when indicated.
淋巴水肿是许多接受乳腺癌治疗的女性面临的一个重大公共卫生问题。尽管据报道体重减轻对淋巴水肿的治疗有益，但迄今为止尚无研究探讨胰高血糖素样肽-1受体激动剂（GLP-1RAs）在继发性淋巴水肿治疗中的应用。本病例报告描述了一名患者，在开始使用GLP-1RAs进行减肥后，其与乳腺癌相关的淋巴水肿得到了显著缓解。
主要症状和/或重要临床发现：术后9个月，患者出现手臂肿胀和功能障碍。在接受辅助化疗和激素治疗期间，她的体重急剧增加，并在4年后达到峰值。与体重增加相对应的是，她的症状明显恶化。
主要诊断、治疗干预及结果：由于辅助性癌症相关体重增加以及通过饮食和运动无法减重，她被转诊进行评估并被诊断为淋巴水肿。患者开始使用胰高血糖素样肽1受体激动剂进行治疗，并在接下来的13个月内体重减轻了24%。她淋巴水肿的改善与体重减轻同步。她的肢体体积差异从10.3%降至3.4%，不再需要穿加压衣。她的影像学检查显示淋巴泵功能恢复，并且通过经过验证的淋巴水肿特异性患者报告结局（PROM）评估，她的生活质量有了显著改善。她仍在接受激素治疗，不再需要加压，并且恢复了规律运动，没有受到影响。
GLP-1RAs为许多受体重增加和淋巴水肿困扰的患者提供了一种潜在的医学选择。在本病例中，我们通过所有客观指标观察到，由于GLP-1RA的作用，淋巴水肿显著减轻且不再需要加压。这也可能将患者的体重指数降低到在有指征时成为淋巴静脉旁路或带血管蒂淋巴结移植的合适候选者的程度。
