From the Guidelines
Recent chemotherapy can increase lactate levels in the body, primarily through mechanisms such as mitochondrial dysfunction and tumor lysis syndrome, which can lead to increased morbidity and mortality if not properly managed. This occurs through several mechanisms, including chemotherapy-induced mitochondrial dysfunction which forces cells to rely more on anaerobic glycolysis for energy production, resulting in increased lactate as a byproduct. Certain chemotherapeutic agents are particularly associated with this effect, although the provided evidence does not directly discuss chemotherapy's impact on lactate levels 1. However, it is known that chemotherapy can cause tissue hypoxia through vascular damage or anemia, further promoting lactate production, similar to how metformin should be avoided in patients at risk for lactic acidosis, such as those with anaerobic metabolism (ie, sepsis, hypoxia) 1. Some key points to consider include:
- Chemotherapy-induced mitochondrial dysfunction
- Tumor lysis syndrome
- Tissue hypoxia due to vascular damage or anemia
- Monitoring lactate levels, especially in patients with risk factors like liver dysfunction or dehydration
- Ensuring adequate hydration and considering temporary pause of chemotherapy in severe cases. It is crucial for clinicians to be aware of these potential effects of chemotherapy on lactate levels to provide timely and appropriate management, thus reducing morbidity, mortality, and improving quality of life.
From the Research
Lactate Levels and Chemotherapy
- Recent chemotherapy can potentially increase lactate levels, as cancer cells are known to rewire their metabolism to support rapid proliferation and survival, leading to increased lactate production 2.
- Lactic acidosis, a condition characterized by elevated lactate levels, is a common metabolic complication in patients with cancer, and chemotherapy can be a contributing factor 3.
- Certain medications, including some chemotherapeutic agents, can induce hyperlactatemia and lactic acidosis, although the exact mechanisms and incidence of these adverse effects are not well established for all medications 4.
Mechanisms and Associations
- Cancer cells can import and utilize lactate as a fuel for energetic purposes, suggesting a potential link between lactate metabolism and cancer progression 2.
- The etiologies of lactate level elevation are diverse and include tissue hypoperfusion, medication-related causes, and underlying diseases such as malignancy 5.
- The clinical and prognostic importance of elevated lactate levels varies widely depending on the underlying disease state, emphasizing the need for tailored therapeutic approaches 5.
Clinical Implications
- Patients with cancer are at risk of developing lactic acidosis due to various factors, including the cancer diagnosis itself, and require intense nursing care and frequent assessments 3.
- Medication-induced lactate level elevations can be diagnosed and managed by clinicians, with strategies including supportive care, exogenous bicarbonate therapy, and medication-specific antidotes 4.