Abstract
Chemotherapy‐induced neutropenia (CIN) has been shown to be associated with improved clinical outcomes in patients with various solid tumors. This study retrospectively assessed the association between timing of CIN and prognosis in 321 patients with advanced gastric cancer (AGC) who finished at least one cycle of chemotherapy with oxaliplatin and capecitabine (XELOX). Primary landmark analyses were restricted to 274 patients who received four cycles of chemotherapy and lived for more than 4 months. CIN was categorized as early‐onset and non‐early‐onset. The correlation between timing of CIN with survival was analyzed by the Kaplan‐Meier method and a Cox proportional hazards model. Relative to patients with non‐early‐onset CIN, those with early‐onset CIN had significantly longer times to disease progression (hazard ratio [HR] 0.574; 95% confidence interval [CI] 0.453–0.729, P < 0.001) and death (HR: 0.607; 95% CI: 0.478–0.770, P < 0.001), consistent with results from the landmark group. In conclusion, timing of CIN may be a potential prognostic biomarker in patients with AGC receiving first‐line chemotherapy with XELOX. Early‐onset CIN predicts better survival.
Highlights
Gastric cancer is the third most common cause of cancer- related deaths worldwide [1]
This study is the first to investigate the association between timing of chemotherapy-induced neutropenia (CIN) and prognosis in patients with advanced gastric cancer (AGC)
Consistent with previous results, we found that the timing of CIN was predictive of survival, with significantly better survival outcomes observed in patients with early-onset than with non-early-onset CIN [5, 8, 11, 14]
Summary
Gastric cancer is the third most common cause of cancer- related deaths worldwide [1]. Compared with best supportive care alone, chemotherapy has resulted in better survival outcomes, fewer symptoms, and improved quality of life in patients with inoperable gastric cancer [3]. Patients may experience varying types and levels of toxicity during chemotherapy, with chemotherapy-induced neutropenia (CIN) being one of the most important dose- limiting toxicities of cytotoxic drugs. An analysis of 1265 patients with non-small-cell-lung-cancer (NSCLC) who received chemotherapy found that neutropenia during chemotherapy was associated with longer survival and lack of neutropenia may indicate underdosing [4].
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