ScienceDirect.com - Gynecologic Oncology - Predictors of severe and febrile neutropenia during primary chemotherapy for ovarian cancer
Objective
To identify factors that increase the risk
of neutropenic events in women with advanced ovarian carcinoma receiving
initial chemotherapy.
Methods
Multi-center
retrospective study of women with FIGO stage III–IV epithelial ovarian
cancer treated postoperatively with multi-agent intravenous chemotherapy
from 1995 to 2008. Outcomes were severe (SN; absolute neutrophil count
[ANC] < 500/mm
3) and febrile neutropenia (FN; ANC < 1000/mm
3
and temperature > 38.1 °C). Cumulative risk of neutropenic events
was estimated by Kaplan Meier method. Multivariate analysis was by Cox
proportional hazard regression.
Results
Three
hundred twenty-six patients met inclusion criteria. There were 251 SN
events among 140 (43%) patients and 24 FN events among 22 (7%) patients.
Univariate predictors of SN were body surface area < 2.0 m
2 (p = 0.03), body mass index (BMI) < 30 kg/m
2
(p < 0.01), Caucasian race (p < 0.01), treatment on research
protocols (p < 0.01), non-carboplatin-containing regimens
(p < 0.01), and planned relative dose intensity (RDI) > 85% of
standard (p = 0.02). Women over age 60 were more likely to develop FN
(p = 0.05). Multivariate predictors of SN were treatment on research
protocols (hazard ratio [HR] 1.93; p < 0.01), Caucasian race (HR
2.13; p = 0.01), and planned RDI > 85% (HR 1.69; p = 0.05);
predictors of FN were age > 60 (HR 2.84; p = 0.05) and
non-carboplatin containing regimens (HR 4.06; p < 0.01).
Conclusion
While
SN is fairly common, FN occurs infrequently in women with EOC
undergoing taxane and platin-based chemotherapy and primary prophylactic
growth factor support is
not indicated. However, women older than
60 years of age receiving non-carboplatin containing regimens are at
higher risk for FN and warrant closer surveillance.
