Tumor lysis syndrome in breast cancer: a systematic review of the literature
- 1The First Clinical Medical College, Guangzhou University of Chinese Medicine
- 2The First Affiliated Hospital of Guangzhou University of Chinese Medicine
- 3Guangdong Provincial Institute of Traditional Chinese Medicine Clinical Research
Abstract
Background: Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency well-characterized in hematologic malignancies but considered rare in solid tumors. In breast cancer, TLS has been documented only in sporadic case reports, and the evolving treatment landscape—including CDK4/6 inhibitors, PI3K inhibitors, novel endocrine agents, and antibody-drug conjugates—may introduce previously unrecognized TLS risks. The only prior review on this topic was published in 2021 and has been superseded by numerous new cases.
Methods: We systematically searched PubMed, Embase, and Web of Science from January 2000 to June 2026 for case reports and case series describing TLS in patients with breast cancer, following PRISMA guidelines. TLS diagnosis was verified against Cairo-Bishop criteria. Data on patient demographics, tumor characteristics, precipitating factors, laboratory abnormalities, management, and outcomes were extracted and analyzed descriptively.
Results: Twenty cases of TLS from 20 publications were identified, with one additional case of successful TLS prevention. All patients had stage IIB–IV disease, with the majority (90%, 18/20) having stage IV disease; liver metastases were present in 55% (11/20). Precipitating factors included endocrine therapy (n=4, 75% mortality), HER2-targeted therapy (n=4, 50% mortality), chemotherapy (n=6, 50% mortality), radiotherapy (n=2, 50% mortality), PI3K inhibitor (n=1, survived), immunotherapy-chemotherapy combination (n=1, survived), and spontaneous TLS (n=2, 50% mortality). Overall TLS-related mortality was 50% (10/20). Endocrine therapy-associated TLS—predominantly aromatase inhibitors—carried the highest mortality (75%, 3/4). The only surviving patient in this group achieved long-term remission following supportive management.
Conclusions: TLS in breast cancer, though rare, carries a high mortality rate approaching 50%. Notably, endocrine therapy—particularly aromatase inhibitors—emerges as a previously underappreciated TLS trigger with disproportionately poor outcomes. With the expanding use of novel targeted and endocrine agents in advanced breast cancer, clinicians should maintain heightened vigilance for TLS, especially in patients with high tumor burden and hepatic metastases. Early recognition and prompt intervention are essential to improve outcomes.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261429658.
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BibTeX
@article{zhang2026tumor,
title = {{Tumor lysis syndrome in breast cancer: a systematic review of the literature}},
author = {Min Zhang and Junli Li and Linhan Zeng and Yao Chen and Xuewu Huang},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1937565},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1937565/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Tumor lysis syndrome in breast cancer: a systematic review of the literature
AU - Min Zhang
AU - Junli Li
AU - Linhan Zeng
AU - Yao Chen
AU - Xuewu Huang
PY - 2026
DA - 2026/10/14
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1937565
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1937565/full
AB - Background: Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency well-characterized in hematologic malignancies but considered rare in solid tumors. In breast cancer, TLS has been documented only in sporadic case reports, and the evolving treatment landscape—including CDK4/6 inhibitors, PI3K inhibitors, novel endocrine agents, and antibody-drug conjugates—may introduce previously unrecognized TLS risks. The only prior review on this topic was published in 2021 and has been superseded by numerous new cases. Methods: We systematically searched PubMed, Embase, and Web of Science from January 2000 to June 2026 for case reports and case series describing TLS in patients with breast cancer, following PRISMA guidelines. TLS diagnosis was verified against Cairo-Bishop criteria. Data on patient demographics, tumor characteristics, precipitating factors, laboratory abnormalities, management, and outcomes were extracted and analyzed descriptively. Results: Twenty cases of TLS from 20 publications were identified, with one additional case of successful TLS prevention. All patients had stage IIB–IV disease, with the majority (90%, 18/20) having stage IV disease; liver metastases were present in 55% (11/20). Precipitating factors included endocrine therapy (n=4, 75% mortality), HER2-targeted therapy (n=4, 50% mortality), chemotherapy (n=6, 50% mortality), radiotherapy (n=2, 50% mortality), PI3K inhibitor (n=1, survived), immunotherapy-chemotherapy combination (n=1, survived), and spontaneous TLS (n=2, 50% mortality). Overall TLS-related mortality was 50% (10/20). Endocrine therapy-associated TLS—predominantly aromatase inhibitors—carried the highest mortality (75%, 3/4). The only surviving patient in this group achieved long-term remission following supportive management. Conclusions: TLS in breast cancer, though rare, carries a high mortality rate approaching 50%. Notably, endocrine therapy—particularly aromatase inhibitors—emerges as a previously underappreciated TLS trigger with disproportionately poor outcomes. With the expanding use of novel targeted and endocrine agents in advanced breast cancer, clinicians should maintain heightened vigilance for TLS, especially in patients with high tumor burden and hepatic metastases. Early recognition and prompt intervention are essential to improve outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261429658.
SN - 2234-943X
ER -