Abstract
PurposeTo assess the predictive ability of the maximum chemiluminescence intensity (CImax) for severe neutropenia (SN) during neoadjuvant chemo(radio)therapy [NAC(RT)] in patients with advanced pancreatic or biliary tract cancer.MethodsClinicopathological variables and blood test data before NAC(RT) were evaluated in 64 patients with advanced pancreatic or biliary tract cancer who received gemcitabine plus tegafur/gimeracil/oteracil as NAC(RT).ResultsThirty-nine patients (60.9%) developed Grade 3–4 SN. The median time between commencing NAC(RT) and the onset of SN was 15 (range 10–36) days. SN occurred during the NAC period, not the RT period. The CImax, neutrophil count, serum interleukin-6 level, C-reactive protein level, complement C3 titer, serum complement titer, and 50.0% hemolytic unit of complement before NAC(RT) were significantly lower in patients with SN than in those without SN (P < 0.05). Multivariate analysis confirmed the CImax to be the sole independent predictor of SN (P < 0.05). The optimal threshold for the CImax was 46,000 RLU/s. The sensitivity and specificity were 46.2% and 80.0%, respectively. Majority of the patients (81.8%) with a low CImax before NAC(RT) experienced SN during NAC(RT).ConclusionsCImax before NAC(RT) predicts SN during NAC(RT) in patients with advanced pancreatic or biliary tract cancer.
Highlights
Majority of the patients with advanced pancreatic or biliary tract cancer have a poor prognosis
The incidence of severe neutropenia (SN) [Grade ≥ 3 according to the Common Terminology Criteria for Adverse Events [8]] was high and has been reported in approximately 62.2% of patients [9]
SN was detected in 39 patients (60.9%), within a median of 15 days from commencing NAC(RT)-gemcitabine plus tegafur/gimeracil/oteracil (GS)
Summary
Majority of the patients with advanced pancreatic or biliary tract cancer have a poor prognosis. Complete surgical resection is currently the only potentially curative treatment for long-term survival. Majority of the patients considered to have localized cancer by radiographic examination have undetected systemic disease and are unlikely to benefit from surgical treatment alone [1, 2]. We have performed NAC(RT)-GS in patients with advanced pancreatic or biliary tract cancer. An adverse effect of anticancer drugs, was frequently observed in patients treated with NAC(RT)GS. The incidence of severe neutropenia (SN) [Grade ≥ 3 according to the Common Terminology Criteria for Adverse Events (version 4.0) [8]] was high and has been reported in approximately 62.2% of patients [9]. SN is a major toxicity that forces a reduction in the relative dose
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