Abstract
AimCombination therapy with gemcitabine and nanoparticle albumin-bound paclitaxel (nab-paclitaxel), known as GnP therapy, significantly prolongs the survival of pancreatic cancer patients compared with gemcitabine monotherapy. However, it may cause severe neutropenia, requiring discontinuation of treatment. This study aimed to clarify the risk factors for Grade 3/4 neutropenia during GnP therapy.MethodsClinical data of pancreatic cancer patients who underwent GnP therapy at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research from December 2014 to December 2016 were retrospectively collected. The relationship of Grade 3/4 neutropenia onset to laboratory values and patient background factors was investigated by multivariate logistic regression analysis.ResultsClinical data of 222 patients were analyzed. Grade 3/4 neutropenia occurred in 118 patients (53.2%) in the first cycle of GnP therapy. Multivariate analysis identified low absolute neutrophil count (ANC), high total bilirubin (T-Bil), and low C-reactive protein (CRP) as risk factors for Grade 3/4 neutropenia. Age was not a risk factor. The incidence of neutropenia was 85.7% in patients with all three risk factors, but only 27.7% in patients with none of them.ConclusionLow ANC, high T-Bil, and low CRP may be risk factors for Grade 3/4 neutropenia in patients receiving GnP therapy, even if these laboratory values are within normal reference ranges. Patients with these risk factors should be carefully monitored for adverse events.
Highlights
Cancer chemotherapy may cause various adverse events, including nausea, hair loss, diarrhea, myelosuppression, liver damage and renal damage
We aimed to identify the risk factors for severe (Grade 3/4) neutropenia using clinical data collected from a larger population of pancreatic cancer patients who received 1–6 cycles of GnP therapy
As factors with p < 0.05, we identified absolute neutrophil count (ANC) < 3.03×103 /μL (OR: 4.806, 95% confidence interval (CI): 2.416–9.558, p = 0.000), total bilirubin (T-Bil) 0.6 mg/dL (OR: 1.964, 95% CI: 1.040–3.708, p = 0.037), and C-reactive protein (CRP) < 0.13 mg/dL (OR: 2.607, 95% CI: 1.331– 5.106, p = 0.005)
Summary
Combination therapy with gemcitabine and nanoparticle albumin-bound paclitaxel (nabpaclitaxel), known as GnP therapy, significantly prolongs the survival of pancreatic cancer patients compared with gemcitabine monotherapy. It may cause severe neutropenia, requiring discontinuation of treatment. This study aimed to clarify the risk factors for Grade 3/4 neutropenia during GnP therapy
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