ペメトレキセド・カルボプラチン併用療法施行患者における重篤な好中球減少症の発現に関する危険因子の同定

Abstract

Pemetrexed plus carboplatin chemotherapy has shown efficacy as a first-line treatment for advanced non-small cell lung cancer. However, severe neutropenia has often been reported as a serious adverse effect after the administration of this combination chemotherapy. Various risk factors associated with severe neutropenia induced by pemetrexed plus carboplatin chemotherapy have not yet been clarified. To clarify the risk factors associated with induced severe neutropenia by pemetrexed plus carboplatin, we retrospectively reviewed the records of 42 patients who had received first-line treatment with this combination chemotherapy at Yamato Municipal Hospital between April 2011 and May 2015. Of the 42 patients, 11 (26.2％) developed grade 3 or 4 neutropenia. Multiple logistic regression analysis showed that the creatinine clearance rate (CCr) of between 45 and 66 mL/min [odds rate: 11.00, 95% confidence interval (CI): 1.26-95.94, P = 0.030] and the co-administration of proton pump inhibitors (PPIs) [odds rate: 9.16, 95% CI: 1.02-82.48, P = 0.048] were significantly related to severe neutropenia in patients treated with pemetrexed plus carboplatin chemotherapy after adjustment with use of non-steroidal anti-inflammatory drugs and body surface area. Therefore, patients with moderately impaired renal function (45 mL/min ≤ CCr < 66 mL/min) or co-administration of PPIs may be risk factors for the development of neutropenia induced by pemetrexed plus carboplatin chemotherapy.