Massacesi C, Marcucci F, Rocchi M B L, Mazzanti P, Pilone A, Bonsignori M
Medical Oncology Department of Ancona, University of Urbino, Italy.
J Chemother. 2004 Feb;16(1):86-93.
We studied factors predicting docetaxel-related toxicity in 113 unselected patients with metastatic cancer treated under routine daily practice. Docetaxel was administered in either a weekly, bi-weekly or tri-weekly schedule. All patients received prophylactic dexamethasone. Twenty-six patients were aged 70 or more, and 28 (24.8%) had an ECOG performance status (PS) score > or = 2. Primary tumors were mainly in breast, lung, and stomach (58, 25, and 14 patients, respectively). Most patients had metastases at two or more sites and were heavily pretreated. NCI-CTC graded toxicities were mild. Grade 3/4 leucopenia and neutropenia occurred in 19.4% and 10.6% of patients, respectively, with febrile neutropenia in 2 patients. Severe nonhematologic toxicities were rare, except for asthenia (8 patients). Complete alopecia occurred in 26.6% of patients. A proportional-odds regression analysis demonstrated that the tri-weekly schedule and older age represented independent risk factors for all-grade leucopenia, whereas a poor PS for anemia. Primary tumor in breast, tri-weekly schedule, an abbreviated and low dose of corticosteroids premedication, and high duration and cumulative dose of docetaxel were factors predicting asthenia. Risk factors for alopecia and vomiting were tri-weekly schedule and high docetaxel cumulative dose, respectively. In conclusion, in daily clinical practice docetaxel toxicity may be correlated with factors related to patient, disease, and treatment characteristics. Taking into account these variables could be a first step toward individualizing treatment.
我们研究了113例在日常常规治疗下的转移性癌症患者中多西他赛相关毒性的预测因素。多西他赛采用每周、每两周或每三周的给药方案。所有患者均接受预防性地塞米松治疗。26例患者年龄在70岁及以上，28例（24.8%）的东部肿瘤协作组（ECOG）体能状态（PS）评分≥2。原发肿瘤主要位于乳腺、肺和胃（分别为58例、25例和14例患者）。大多数患者有两个或更多部位的转移，且接受过大量预处理。美国国立癌症研究所常见毒性标准（NCI-CTC）分级的毒性为轻度。3/4级白细胞减少和中性粒细胞减少分别发生在19.4%和10.6%的患者中，2例患者出现发热性中性粒细胞减少。除乏力（8例患者）外，严重的非血液学毒性罕见。26.6%的患者出现完全脱发。比例优势回归分析表明，每三周给药方案和年龄较大是所有级别的白细胞减少的独立危险因素，而PS较差是贫血的危险因素。乳腺原发肿瘤、每三周给药方案、简化且低剂量的皮质类固醇预处理以及多西他赛的高疗程和累积剂量是预测乏力的因素。脱发和呕吐的危险因素分别是每三周给药方案和多西他赛的高累积剂量。总之，在日常临床实践中，多西他赛毒性可能与患者、疾病和治疗特征相关的因素有关。考虑这些变量可能是实现个体化治疗的第一步。
