Could a low-cost, easily implemented presurgical intervention save lives and improve outcomes when it comes to treating solid tumors? For patients with early-stage breast cancer, a new study suggests there is such an intervention that can help.
Researchers followed 1,583 women with early breast cancer planned for upfront surgery without prior neoadjuvant treatment. They found that peritumoral injection of lidocaine before surgery significantly increased disease-free survival and overall survival after a median of 5 years of follow-up (J Clin Oncol 2023; doi: 10.1200/JCO.22.01966).
In a statement published with the article, Kathy D. Miller, MD, Senior Deputy Editor for the publication, said, "This study challenges assumptions, suggesting that small, inexpensive changes in technical aspects of surgery may reduce metastasis."
The study's lead author, Rajendra A. Badwe, MS, Director of Tata Memorial Centre of the Homi Bhabha National Institute in Mumbai, India, told Oncology Times that previous work from their group found that events at the time of surgery may account for who gets metastases.
"There is evidence that removal of the primary tumor may either disseminate tumor cells or stimulate growth of preexisting micrometastases," the study authors noted in the paper. "Modulating events at the time of surgery to improve survival has been attempted only with limited success. Local anesthetic agents are known to modulate non-receptor tyrosine-protein kinases and voltage-gated sodium channels."
So suppression of these pathways might inhibit cell proliferation, which could in turn reduce metastases. That's the hypothesis Badwe and colleagues set out to look at in their new work. Previous retrospective studies may be a benefit to local anesthesia during primary surgery for breast cancer. However, other reviews that have looked at the question conclude that the evidence until now has been too sparse to make a recommendation for or against its use.
Routine Clinical Practice?
According to Badwe, this study has practice-changing implications. "This is robust evidence begging to be implemented in routine clinical practice in breast cancer surgery. A 29 percent relative reduction in death would mean saving thousands of lives using a simple and implementable intervention globally at a cost that is under $10 per patient," Badwe said.
An editorial accompanying the article came to the same conclusion (J Clin Oncol 2023; doi: 10.1200/JCO.23.00418). "It seems reasonable to introduce this intervention as an easy, cost-effective intervention that may reduce the rates of recurrence and death in women with early-stage breast cancer," the authors noted.
Additionally, they noted that this type of perioperative use of local anesthesia has the additional benefits of providing pain relief and decreasing intraoperative and postoperative opioid use, thus reducing postoperative nausea and vomiting, as well as facilitating enhanced recovery after surgery.
Study Details
For this study, the researchers followed 1,583 women with early breast cancer across 10 cancer centers in India. They were randomly allocated to either receive peritumoral injection of local anesthetic lidocaine or not. They then received standard locoregional and systemic treatment for both arms and were followed up till recurrence and or death.
The following occurred after 5 years of follow-up:
* Disease-free survival for the women who received lidocaine was 86.6 percent versus 82.6 percent for the women who did not receive the anesthetic.
* Overall survival was 90.1 percent for the women who received the lidocaine versus 86.4 percent for the women who did not receive the anesthetic.
* The impact of lidocaine was similar in subgroups defined by menopausal status, tumor size, nodal metastases, and hormone receptor and human epidermal growth factor receptor 2 status; and
* 5-year cumulative incidence rates of locoregional recurrence were 3.4 percent and 4.5 percent (for those receiving lidocaine vs. those who did not, respectively), and distant recurrence rates were 8.5 percent and 11.6 percent, respectively.
* Finally, the study reported there were no adverse events linked to the lidocaine injection.
The study authors hope to continue exploring if the benefits can be seen when it comes to surgery to remove other types of solid tumors, too. "The next step is to test molecules with stronger suppression of voltage-gated channels in all solid tumors that are treated by primary surgery," Badwe noted.
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