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Can grade 2 neutropenia predict the risk of grade 3 neutropenia in metastatic colorectal cancer patients treated with chemotherapy?

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Abstract

Purpose

Neutropenia is a major factor affecting continuation of chemotherapy for colorectal cancer. In many clinical trials, a neutrophil count of >1500 is targeted for continuation; for a count of <1500, medication is commonly discontinued. However, there is no definitive evidence supporting the need for a neutrophil count of 1500 for continuation of chemotherapy. In the clinical trials that we conducted, we discontinued chemotherapy when the neutrophil count was <1000 (grade 3); for a count of 1000–1500 (grade 2), chemotherapy was continued. Therefore, even practical treatment uses the same setting. Our aim was to examine neutrophil counts during continuation of chemotherapy in colorectal cancer patients with counts of 1000–1500 and to assess the need for discontinuation of medication for neutrophil counts in this range. Moreover, we examined neutrophil counts during the previous course of chemotherapy when they fell below 1000.

Methods

The study included 144 patients who received XELOX + bevacizumab therapy and XELOX therapy for advanced or recurrent colorectal cancer.

Results

Thirty (20.8 %) patients had neutrophil counts of 1000–1500. One (3.3 %) of 30 patients had a neutrophil count of <1000 during the following course of chemotherapy. Moreover, among the patients with neutrophil counts of <1000, 27.3 % had counts of 1000–1500 during the previous course of chemotherapy and 72.7 % had counts of >1500.

Conclusions

Based on these results, grade 2 neutropenia cannot predict the risk of grade 3 neutropenia. Continuation of chemotherapy in patients with neutrophil counts of 1000–1500 may be appropriate, and discontinuation of therapy is not always required.

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References

  1. Network NCC (2010) NCCN clinical practice guidelines in oncology. Myeloid growth factors. v. 1.2010. NCCN Web site

  2. Lee SY, Kang HR, Song WJ, Lee KH, Han SW, Cho SH (2014) Overcoming oxaliplatin hypersensitivity: different strategies are needed according to the severity and previous exposure. Cancer Chemother Pharmacol 73(5):1021–1029

    Article  CAS  PubMed  Google Scholar 

  3. Crawford J, Dale DC, Lyman GH (2004) Chemotherapy‐induced neutropenia. Cancer 100(2):228–237

    Article  PubMed  Google Scholar 

  4. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106(10):2258–2266

    Article  PubMed  Google Scholar 

  5. Bennouna J, Sastre J, Arnold D, Österlund P, Greil R, Van Cutsem E et al (2013) Continuation of bevacizumab after first progression in metastatic colorectal cancer (ML18147): a randomised phase 3 trial. Lancet Oncol 14(1):29–37

    Article  CAS  PubMed  Google Scholar 

  6. Rothenberg M, Cox J, Butts C, Navarro M, Bang Y-J, Goel R et al (2008) Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) as second-line therapy in metastatic colorectal cancer: a randomized phase III noninferiority study. Ann Oncol 19(10):1720–1726

    Article  CAS  PubMed  Google Scholar 

  7. Sobrero A, Young S, Balcewicz M, Chiarra S, Perez Carrion R, Mainwaring P et al (2007) Phase IV study of first-line bevacizumab plus irinotecan and infusional 5-FU/LV in patients with metastatic colorectal cancer: AVIRI. J Clin Oncol : Off J Am Soc Clin Oncol 25:A4068

    Google Scholar 

  8. Fisher GA, Kuo T, Ramsey M, Schwartz E, Rouse RV, Cho CD et al (2008) A phase II study of gefitinib, 5-fluorouracil, leucovorin, and oxaliplatin in previously untreated patients with metastatic colorectal cancer. Clin Cancer Res 14(21):7074–7079

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Toffoli G, Cecchin E, Corona G, Russo A, Buonadonna A, D’Andrea M et al (2006) The role of UGT1A1* 28 polymorphism in the pharmacodynamics and pharmacokinetics of irinotecan in patients with metastatic colorectal cancer. J Clin Oncol 24(19):3061–3068

    Article  CAS  PubMed  Google Scholar 

  10. Saltz LB, Meropol NJ, Loehrer PJ, Needle MN, Kopit J, Mayer RJ (2004) Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol 22(7):1201–1208

    Article  CAS  PubMed  Google Scholar 

  11. Jeong J, Jeung H-C, Rha S, Im C, Shin S, Ahn J et al (2008) Phase II study of combination chemotherapy of 5-fluorouracil, low-dose leucovorin, and oxaliplatin (FLOX regimen) in pretreated advanced gastric cancer. Ann Oncol 19(6):1135–1140

    Article  CAS  PubMed  Google Scholar 

  12. Gruenberger B, Tamandl D, Schueller J, Scheithauer W, Zielinski C, Herbst F et al (2008) Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol 26(11):1830–1835

    Article  CAS  PubMed  Google Scholar 

  13. Yoshida Y, Hoshino S, Aisu N, Naito M, Miyake T, Tanimura S et al (2013) Pilot study of the early start of chemotherapy after resection of primary colorectal cancer with distant metastases (Pearl Star 01). World J Surg Oncol 11(1):39

    Article  PubMed Central  PubMed  Google Scholar 

  14. Yoshida Y, Hasegawa J, Nezu R, Kim YK, Hirota M, Kawano K et al (2011) Clinical usefulness of mitochondrial transcription factor A expression as a predictive marker in colorectal cancer patients treated with FOLFOX. Cancer Sci 102(3):578–582

    Article  CAS  PubMed  Google Scholar 

  15. Yoshida Y, Hoshino S, Aisu N, Shiwaku H, Beppu R, Tanimura S, et al. (2012) Dexamethasone as a means not only for controlling vascular pain caused by the administration of oxaliplatin via the peripheral vein but also for controlling oxaliplatin-induced hypersensitivity reactions. Br J Med Med Res 2(2):132–141

  16. Yoshida Y, Hoshino S, Aisu N, Naito M, Tanimura S, Sasaki T et al (2014) Efficacy of XELOX plus bevacizumab in brain metastasis from rectal cancer. Case Rep Oncol 7(1):117–121

    Article  PubMed Central  PubMed  Google Scholar 

  17. Yoshida Y, Hoshino S, Shiwaku H, Beppu R, Tanimura S, Tanaka S et al (2011) Early start of chemotherapy after resection of primary colon cancer with synchronous multiple liver metastases: a case report. Case Rep Oncol 4(2):250–254

    Article  PubMed Central  PubMed  Google Scholar 

  18. Yoshida Y, Hoshino S, Yamashita Y. Timing of initiation of chemotherapy after primary colorectal cancer resection. The Research and Biology of Cancer II, Edited by iConcept Press Ltd, 01/2014: chapter Timing of Initiation of Chemotherapy after Primary Colorectal Cancer Resection

  19. Yoshida Y, Hoshino S, Aisu N, Naito M, Tanimura S, Mogi A, et al. Administration of chemotherapy via the median cubital vein without implantable central venous access ports: port-free chemotherapy for metastatic colorectal cancer patients. International Journal of Clinical Oncology. 2014:1–6. doi:10.1007/s10147-014-0703-5

  20. Lyman GH, Dale DC, Crawford J (2003) Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: a nationwide study of community practices. J Clin Oncol 21(24):4524–4531

    Article  PubMed  Google Scholar 

  21. Wood WC, Budman DR, Korzun AH, Cooper MR, Younger J, Hart RD et al (1994) Dose and dose intensity of adjuvant chemotherapy for stage II, node-positive breast carcinoma. N Engl J Med 330(18):1253–1259

    Article  CAS  PubMed  Google Scholar 

  22. Hochster H, Hart L, Ramanathan R, Hainsworth J, Hedrick E, Childs B (2006) Safety and efficacy of oxaliplatin/fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer (mCRC): final analysis of the TREE-study. J Clin Oncol : Off J Am Soc Clin Oncol 24(18S):3510

    Google Scholar 

  23. Cassidy J, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R et al (2008) Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol 26(12):2006–2012

    Article  CAS  PubMed  Google Scholar 

  24. Ducreux M, Bennouna J, Hebbar M, Ychou M, Lledo G, Conroy T et al (2011) Capecitabine plus oxaliplatin (XELOX) versus 5‐fluorouracil/leucovorin plus oxaliplatin (FOLFOX‐6) as first‐line treatment for metastatic colorectal cancer. Int J Cancer 128(3):682–690

    Article  CAS  PubMed  Google Scholar 

  25. Aapro MS, Cameron DA, Pettengell R, Bohlius J, Crawford J, Ellis M et al (2006) EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 42(15):2433–2453

    Article  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflicts of interest.

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Correspondence to Yoichiro Yoshida.

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Yoshida, Y., Hoshino, S., Aisu, N. et al. Can grade 2 neutropenia predict the risk of grade 3 neutropenia in metastatic colorectal cancer patients treated with chemotherapy?. Support Care Cancer 23, 1623–1627 (2015). https://doi.org/10.1007/s00520-014-2518-3

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  • DOI: https://doi.org/10.1007/s00520-014-2518-3

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