Neutropenic complications with carboplatin AUC 5 and paclitaxel 175 mg/m2 (CP) regimen in Indian patients: A community-based single center experience.

Abstract

e19607 Background: In most oncology clinical trials, the majority of patients are of Caucasian ethnicity. It is often difficult to apply the same chemotherapy with equal dose intensity in Indian patients due to increased risk of complications. The exact incidence of complications & whether the difference in chemotherapy tolerability is due to genetic or environmental factors remain unclear. We provide a community-based single center experience with the commonly used CP regimen in Indian patients. Methods: A retrospective study of all patients who received CP regimen (Cockroft Gault formula for CrCl) from September 2010 to December 2011 was undertaken. Incidence of neutropenic complications, G-CSF utilization & pRBC transfusion was determined. Results: Fifty six patients received 194 cycles of CP (range 1-8 cycles, median 3 cycles, mean paclitaxel dose 256mg, mean carboplatin dose 431mg, average BSA 1.56). Clinical characteristics : male 16, female 40; age range 34 - 82 yrs, median 55 yrs; site - breast 6, ovary 19, cervix/uterus 11, esophagus 8, others 12; stage – I/II/III 7, IV 42; histology – SCC 21, Adenoca 34. After the 1st cycle, there were 8 neutropenic complications (14%)- 4 patients (7%) with neutropenia (ANC<1500 cells/mm3) and 4 patients (7%) with neutropenic fever. Forty-two patients received the 2nd cycle, & in total 12 patients required G-CSF support (28%). There were 3 deaths, 2 due to neutropenic fever & sepsis. Average baseline hemoglobin was 11.5gm/dl with 5 episodes of pRBC transfusion. Conclusions: Although the incidence of neutropenia in Indian patients receiving CP is not higher than previous reports (20-25%), there is a much higher incidence of neutropenic fever (over the reported 1-2%) & death, resulting in high G-CSF utilization. This raises several issues such as the role of prophylactic antibiotics, impact of environmental & socio-economic factors (compromised nutritional status & hygiene, lack of disease insight & lack of access to urgent health care). We will need to implement additional measures, increase patient & family awareness by frequent education & counseling so as to reduce complications & improve clinical outcomes in Indian patients.