Lidocaine Injection Around the Tumour Before Breast Cancer Surgery Improves Outcomes
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Breast cancer is the most common cancer worldwide, with more than 2 million new cases each year. Early diagnosis and effective treatment can substantially improve survival and quality of life. A recent study found that preoperative peritumoral lidocaine injection, given around the tumour, improved overall and disease-free survival in patients with breast cancer. This article discusses the study and its findings.
Breast cancer stages reflect how far the disease has spread and influence treatment options. Operable stages, stage 1 and stage 2, are considered early breast cancer. Patients with stage 3 or 4 generally receive systemic treatment first, with surgery considered afterwards. Worldwide, an estimated 60-70% of breast cancers are diagnosed early, at stage 1 or stage 2.
On 6 April 2023, Journal of Clinical Oncology published a study showing that injecting lidocaine around the tumour immediately before surgery significantly improved disease-free and overall survival (OS) in patients with breast cancer who underwent surgery directly after diagnosis without neoadjuvant treatment.
Lidocaine and Cancer
Lidocaine is an amide drug widely used for its local anaesthetic effects. First synthesised in 1943 by the Swedish scientist Nils Löfgren, it is mainly used for temporary pain relief. It can be injected or applied as a cream or spray to provide local anaesthesia for dentistry, minor surgery and certain medical procedures. It can also be used as an antiarrhythmic to treat irregular heart rhythms.
Use of lidocaine in cancer research has increased in recent studies. Research into its antitumour effects suggests that it may help inhibit cancer cell growth and spread. Studies on breast and lung cancer cells have demonstrated antitumour effects through activation of programmed cell death, or apoptosis, and reduction of cell numbers.
However, research into lidocaine in cancer remains relatively new, and further studies are needed. Clinical trials are continuing to better understand the effects of lidocaine use before and after cancer surgery. They will provide more information about its potential benefits and effectiveness in cancer treatment.
A Study Involving 1500 Patients
In an open-label, randomised, phase 3 clinical trial, researchers investigated the potential antimetastatic effects of local anaesthetic injections given 7-10 minutes before tumour removal during surgery for early breast cancer.
The study, conducted at 11 centres in India, included 1583 evaluable patients with breast cancer. They were divided into two groups: those receiving a preoperative injection of 0.5% lidocaine around the tumour (786 patients) and those not receiving it (797 patients). Baseline characteristics were balanced between the groups.
- Mean follow-up was 69 months, and the primary endpoint was disease-free survival (DFS). The 5-year DFS rate in the lidocaine group was 86.6% and in patients who did not receive lidocaine it was 82.6% (hazard ratio [HR], 0.74; 95% CI, 0.58-0.95; P =0.017).
- The 5-year locoregional recurrence rate was 3.2% with lidocaine and 4.1% in the control group (subdistribution HR [SHR], 0.69; 95% CI, 0.42-1.13).
- The 5-year distant recurrence rate was 8.1% and 10.9%, respectively (SHR, 0.74; 95% CI, 0.54-1.01).
- The 5-year overall survival rate was 90.1% in patients receiving lidocaine and 86.4% in those not receiving it (HR, 0.71; 95% CI, 0.53-0.94; P =0.019).
No lidocaine-related adverse effects were observed.
In conclusion, injecting lidocaine around the tumour before breast cancer surgery was shown to benefit disease-free and overall survival. The study demonstrates that treatments given during and after surgery can substantially affect survival and quality of life in people with cancer. Future studies should therefore explore and evaluate similar interventions for early breast cancer. Such approaches may represent important steps towards further improving survival and quality of life.
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