Impact of baseline hypoalbuminemia on peripheral edema induced by gemcitabine and nab-paclitaxel for pancreatic cancer treatment.

Abstract

Background: Gemcitabine (GEM) + nanoparticle albumin-bound paclitaxel (nab-PTX), which is effective in treating pancreatic cancer, frequently induces peripheral edema. Hypoalbuminemia causes generalized peripheral edema and occasionally occurs in patients with cancer, but reports evaluating its interaction with chemotherapy-induced symptoms are lacking. Therefore, we aimed to assess the effect of baseline hypoalbuminemia on peripheral edema following real-world GEM + nab-PTX therapy.

Methods: Patients with pancreatic cancer receiving GEM + nab-PTX (n = 212) were divided into a hypoalbuminemia group (serum albumin levels < 3.5 g/dL), and a control group without hypoalbuminemia, and retrospectively evaluated. The primary endpoint was the incidence of grade ≥ 2 peripheral edema within 6 months of treatment initiation.

Results: The incidence of grade ≥ 2 peripheral edema within 6 months was 5.7% in the control group and 22.6% in the hypoalbuminemia group, with a significant difference (P = 0.0009), meeting the primary endpoint. The onset time of grade ≥ 2 peripheral edema was significantly earlier in the hypoalbuminemia group than in the control group (P = 0.0003). In contrast, the incidence of all-grade symptoms was 20.1% in the control group and 30.2% in the hypoalbuminemia group, which was not significantly different (P = 0.13). These results were confirmed in the propensity score-matched population. Multivariate Cox proportional hazard regression analyses showed that baseline hypoalbuminemia was a significant risk factor for grade ≥ 2 peripheral edema (adjusted hazard ratio, 3.84; 95% confidence interval, 1.60-9.23; P = 0.003).

Conclusion: Our study revealed that patients with baseline hypoalbuminemia who received GEM + nab-PTX therapy for pancreatic cancer developed problematic peripheral edema.