Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)

 

Hypertrophic Pulmonary Osteoarthropathy (HPOA): An Unusual But Distinctive Complication of Lung Cancer
Author
Howard (Jack) West, MD

Although it's uncommon, hypertrophic osteoarthropahy, or HPOA, is an odd and therefore memorable syndrome that can be a side effect of lung cancer. It features an abnormal proliferation of skin and bone tissue, primarily in the hands and feet. Patients can develop clubbing, which is most commonly associated with NSCLC (up to 1/3 of patients) more than SCLC (only about 5%), and adenocarcinoma in particular. Here's what it looks like:

nail clubbing Clubbing

Other features include a buildup of bone in the ends of long bones, and sometimes an effusion (fluid collection) in the joints, particularly large joints.

Patients will often feel painful joints (arthritis/arthopathy), which can look a lot like typical arthritis, particularly when the pain precedes clubbing. But in some cases, that joint pain is an early symptom of lung cancer. What's interesting is that if patients with an early stage NSCLC and HPOA undergo surgery, their joint pain can resolve pretty much as soon as they come out of surgery (imagine coming out of lung surgery with less pain than you started with!).

Why does this happen? One possibility is that platelets, or the predecessor to platelets known as megakaryocytes (which break up into many, many platelets), get out to the ends of the extremities and becomes activated there. That activation can release growth factors such as platelet-derived growth factor (PDGF), which is also known as fibroblast growth factor and can lead to abnormal tissue growth in that area. Another theory is that a factor like vascular endothelial growth factor (VEGF), which is the target of avastin (bevacizumab), may produce this response. There have been rare case reports of patients with HPOA who have also had very high blood levels of VEGF, and in one case the resolution of symptoms corresponded with a rapid drop in VEGF levels after surgery to remove the lung cancer.

This might suggest that antiangiogenic agents, which work largely by inhibiting VEGF activity, may be particularly effective in alleviating symptoms from HPOA in patients with more advanced lung cancer, though I don't believe that's really been reported yet. Another approach that has occasionally been reported as being effective against HPOA is bisphosphonate therapy (medications typically used to reduce progression of bony metastases or osteoporosis), such as zometa or pamidronate. Otherwise, as with surgery, we hope that chemotherapy or other treatments that can treat the underlying cancer effectively can also improve the related syndrome of HPOA.

Next Previous link

Previous PostNext Post

Related Content

Image
Trial data ASCO 2024
Video
In this video series from ASCO 2024, Drs. Aakash Desai and Fauwzi Abu Rous discuss trial dates and clinical data as presented at the 2024 ASCO. To watch the complete playlist, click here.         
Image
Bladder Cancer Video Library 2024
Video
Dr. Petros Grivas discusses intravesical treatment for patients with nonmuscle invasive, or early-stage, bladder cancer, the importance of participating in clinical trials for bladder cancer, combination therapy options for patients with metastatic or incurable bladder cancer, and the importance of family history of cancer and discussing that history with your doctor.
Image
Case Based Panel
Video
The panel discusses treatment options for a patient diagnosed with EGFR Exon 19 Deletion NSCLC and examines data from the Laura Trial, a patient with a smoking history and diagnosis of small cell lung cancer, and how the Adriatic Study factors into decisions, and a patient with NSCLC adenocarcinoma, and a EGFR Exon 21 L858R Alteration, and how data from the Flaura 2 Trial can impact treatment decisions.

Forum Discussions

Hi elysianfields and welcome to Grace.  I'm sorry to hear about your father's progression. 

 

Unfortunately, lepto remains a difficult area to treat.  Recently FDA approved the combo Lazertinib and Amivantamab...

Hello Janine, thank you for your reply.

Do you happen to know whether it's common practice or if it's worth taking lazertinib without amivantamab? From all the articles I've come across...

Hi elysianfields,

 

That's not a question we can answer. It depends on the individual's health. I've linked the study comparing intravenous vs. IV infusions of the doublet lazertinib and amivantamab...

Recent Comments

JOIN THE CONVERSATION
I could not find any info on…
By JanineT GRACE … on
Hi elysianfields,

 

That's…
By JanineT GRACE … on
Hello Janine, thank you for…
By elysianfields on
EGFR
By happybluesun on