Febrile Neutropenia Rates in Men Treated with Docetaxel Chemotherapy for Metastatic Hormone-sensitive Prostate Cancer

Abstract

Madam d Recent clinical trials proving the benefi to f docetaxel chemotherapy in hormone-sensitive metastatic prostate cancer (HSMPC) have reported a greater risk of febrile neutropenia than seen in the castrate-resistant setting. STAMPEDE [1] reported 15%, CHAARTED [2] 6% and GETUG-AFU15 [3] 7% grade 3e5 febrile neutropenia in comparison with Tax-327 [4], which showed 3% febrile neutropenia. Clinical experience at The Christie suggested the risk of febrile neutropenia was higher than that experienced in these trials. ASCO guidelines [5] recommend using colony stimulating factors (CSFs) prophylactically when the febrile neutropenia risk is � 20%. An audit was conducted to establish febrile neutropenia rates in HSMPC patients referred to The Christie for docetaxel chemotherapy between 1 June 2015 and 1 February 2016. In total, 53 patients (all World Health Organization performance status 0/1) were eligible for inclusion. The median age was 65 years (range 43e79). The audit confirmed that 30% (16 of 53) of patients developed febrile neutropenia (defined as ANC <1.0, fever � 37.5 � C requiring admission and antibiotic treatment). Eighteen episodes of febrile neutropenia, involving 16 patients, were recorded with 12 episodes occurring after cycle 1. Ten did not complete the prescribed course of chemotherapy due to toxicity. Our findings suggest that patients receiving docetaxel in the HSMPC setting experience high rates of febrile neutropenia. We recommend the use of G-CSF from cycle 1 onwards when using docetaxel in the HSMPC setting. This is in keeping with findings from GETUG-AFU15, where after four treatment-related deaths the use of G-CSF was mandated. We suggest that further work is required to investigate why men treated in the hormone-sensitive setting are much more likely to experience febrile neutropenia than in the hormone-resistant setting.