1625 - Neutropenia in lung cancer patients treated with chemotherapy in a routine clinical practice - an institutional experience

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Complications of Treatment
Lung and other Thoracic Tumours
Presenter Nina Hitij
Authors N.T. Hitij1, K. Mohorcic2, A. Sadikov3, T. Cufer4
  • 1University Clinic Golnik, 4204 - Golnik/SI
  • 2Department Of Medical Oncology, University Clinic Golnik, 4204 - Golnik/SI
  • 3Department Of Artificial Intelligence, Faculty of computer and information science Ljubljana, 1000 - Ljubljana/SI
  • 4Medical Oncology Unit, University Clinic Golnik, 4204 - Golnik/SI

Abstract

Background

Febrile neutropenia (FN) is a serious complication of chemotherapy (ChT). Lung cancer patients are fragile with much comorbidity mostly receiving intermediate FN (iFN) risk ChT schemas and primary prophylaxis with granulocyte colony-stimulating factors (ppG-CSF) should be used in a majority of pts according to recommendations. A routine use of ppG-CSF in clinical practice seems to be variable. Therefore, we conducted a retrospective analysis of lung cancer pts treated with ChT in a routine clinical practice at University Clinic Golnik (2009-2011), estimating the rate and severity of neutropenia, the rate of FN and treatment strategies.

Patients and methods

A typical collective of 190 pts with advanced lung cancer (SCLC 29% and NSCLC 71%) treated with ChT alone were included. Most pts received platinum based ChT (cisplatin 64.7%, carboplatin 20.0%), only 15.3% received other ChT schemas. For most of the pts it was first line ChT (86.8%). Majority of the pts received 6 cycles of ChT (46.3%), 53.7% of pts received 2-6 cycles. Only one patient received ppG-CSF.

Results

Neutropenia at any time during ChT was recorded in 100/190 (52.6%) of pts, in 60/190 (31.6%) of pts it was grade 3 or 4. FN was recorded in 16/190 (8.4%) of pts. Mostly, neutropenia developed after the first three cycles of ChT (76.0%). One patient died due to FN. There was no correlation between occurrence of neutropenia and cisplatin- vs. carboplatin- based ChT, nor the line of ChT. Secondary prophylactic G-CSF was used in 14/190 (7.4%) of pts, 8 of them received G-CSF after the episode of FN, and 6 of them due to higher grade neutropenia without FN. All pts with FN received standard antibiotic treatment, while secondary prophylaxis with G-CSF has not been initiated in 8 pts due to the dose reduction in following cycles and death in one case. No patient suffered from recurrent FN episode.

Conclusion

Despite a negligible use of ppG-CSF in our collective of pts a very low rate of FN (8.4%) was observed. Due to retrospective nature of the analysis we certainly might have missed some cases of FN, less likely there were some major complications due to missed FN. Based on this retrospective analysis we cannot neglect the use of ppG-CSF in lung cancer patients receiving iFN risk ChT, though, the actual proportion of patients needing ppG-CSF is questionable.

Disclosure

All authors have declared no conflicts of interest.