From the Guidelines
A lactate dehydrogenase (LDH) level of 7100 in a patient with advanced metastatic breast cancer indicates a very serious condition with a generally poor prognosis, but survival remains possible depending on multiple factors. Elevated LDH at this level reflects extensive tumor burden and tissue damage, as LDH is released when cells break down. While this high value correlates with reduced survival rates, individual outcomes vary significantly based on the patient's overall condition, age, comorbidities, treatment response, and cancer subtype. Some patients with markedly elevated LDH can respond to aggressive treatment approaches including chemotherapy regimens (such as taxanes, anthracyclines, or platinum agents), targeted therapies (like trastuzumab for HER2+ disease or CDK4/6 inhibitors for hormone-positive disease), or immunotherapies depending on the cancer's molecular profile 1.
Key Considerations
- Treatment decisions should be made promptly, focusing on both cancer-directed therapy and supportive care to manage complications.
- The extremely high LDH level may indicate complications like liver metastases, tumor lysis syndrome, or other organ dysfunction that require immediate medical attention alongside cancer treatment.
- Patient's preferences and overall condition should be taken into account when making treatment decisions, as stated in the ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer 1.
- The use of telemedicine and specialized oncology nurses can also play a crucial role in the management of patients with advanced breast cancer, as suggested by the 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) 1.
Treatment Approaches
- Chemotherapy regimens, such as taxanes, anthracyclines, or platinum agents, may be considered for patients with advanced metastatic breast cancer.
- Targeted therapies, like trastuzumab for HER2+ disease or CDK4/6 inhibitors for hormone-positive disease, can also be effective in managing the disease.
- Immunotherapies may be an option for some patients, depending on the cancer's molecular profile.
Prognosis and Survival
- While the prognosis for patients with advanced metastatic breast cancer is generally poor, some patients can achieve meaningful survival periods with appropriate interventions.
- The 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) suggest that patients with advanced breast cancer can live many years with their disease under control or in complete remission, with a median overall survival of about 3 years and a 5-year survival rate of around 25% 1.
From the Research
LDH Levels and Survival in Metastatic Breast Cancer
- An LDH level of 7100 in a patient with advanced metastatic breast cancer is significantly elevated, as normal LDH levels are typically considered to be below 250 IU/L 2.
- Elevated LDH levels are associated with worse prognosis in various malignancies, including metastatic breast cancer (MBC) 3, 2.
- A study found that patients with abnormal baseline LDH levels (> 250 IU/L) had significantly shorter overall survival (OS) compared to those with normal baseline LDH levels 2.
- Another study confirmed that plasmatic LDH is an independent prognostic factor in MBC, and patients who maintained elevated LDH levels after 12 weeks of first-line treatment experienced worse progression-free survival (PFS) and OS compared to patients with stable normal LDH levels 3.
Treatment and Management
- Bisphosphonates are commonly used in the treatment of metastatic breast cancer to prevent or delay skeletal-related events and improve pain control 4, 5, 6.
- These medications can reduce the frequency of morbid skeletal events by 30-40% in breast cancer metastatic to bone 5.
- However, the use of bisphosphonates does not directly address the issue of elevated LDH levels, and their effectiveness in improving survival outcomes in patients with advanced metastatic breast cancer and high LDH levels is not well established.
Prognostic Value of LDH
- LDH levels have been shown to have prognostic value for survival and chemotherapeutic response in patients with advanced triple-negative breast cancer 2.
- Changes in LDH levels after first-line chemotherapy have been associated with PFS and the chemotherapeutic response in patients with advanced TNBC 2.
- However, the prognostic value of LDH in patients with other subtypes of breast cancer is not as well understood, and further research is needed to fully elucidate the role of LDH in breast cancer prognosis.