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多西他赛化疗致非小细胞肺癌患者发热性中性粒细胞减少的危险因素。

Risk Factors for Febrile Neutropenia Induced by Docetaxel Chemotherapy in Patients with Non-small Cell Lung Cancer.

机构信息

Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences.

Department of Pharmacy, Kobe City Medical Center General Hospital.

出版信息

Biol Pharm Bull. 2020 Aug 1;43(8):1235-1240. doi: 10.1248/bpb.b20-00266. Epub 2020 May 21.

Abstract

We retrospectively obtained data of patient background and pretreatment characteristics from medical records and identified the predictive factors of febrile neutropenia (FN) in patients with non-small cell lung cancer (NSCLC) treated with docetaxel alone or in combination with the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab. Patients were eligible for inclusion in the study if they were 20 years or older, diagnosed with NSCLC, and received docetaxel monotherapy alone or in combination with bevacizumab at the Department of Respiratory Medicine, Kobe City Medical Center General Hospital, between July 1, 2011, and March 31, 2018. Eighty-one patients with recurrent or advanced NSCLC were included. Multivariate stepwise logistic regression analysis with backward selection revealed that lower baseline Eastern Cooperative Oncology Group performance status (ECOG-PS) scores of 1 and 2 (odds ratio (OR), 5.098; 95% confidence interval (CI), 1.045-24.879, p = 0.021) and baseline platelet count below 18.8 × 10/µL (OR, 3.861; 95% CI, 1.211-12.311, p = 0.022) were significant factors influencing the FN occurrence rate. Our results demonstrated that ECOG-PS 1-2 and lower baseline platelet count were significant risk factors of FN in patients with NSCLC receiving docetaxel-based chemotherapy. Moreover, the combination of anti-VEGF antibodies and docetaxel might be associated with increased FN frequency. Despite the limitations of this study including its retrospective design, single-center site, and small sample size, baseline ECOG-PS score and platelet count may be regarded as important indices to identify patients for prophylactic granulocyte-colony stimulating factor (G-CSF) treatment before docetaxel-based chemotherapy.

摘要

我们从病历中回顾性地获得了患者背景和预处理特征的数据,并确定了接受多西他赛单药或联合抗血管内皮生长因子(VEGF)抗体贝伐珠单抗治疗的非小细胞肺癌(NSCLC)患者发生发热性中性粒细胞减少症(FN)的预测因素。如果患者年龄在 20 岁或以上,诊断为 NSCLC,并在神户市立医疗中心综合医院呼吸内科接受多西他赛单药或联合贝伐珠单抗治疗,患者即有资格入组研究。该研究纳入了 2011 年 7 月 1 日至 2018 年 3 月 31 日期间在神户市立医疗中心综合医院呼吸内科接受多西他赛单药或联合贝伐珠单抗治疗的 81 例复发性或晚期 NSCLC 患者。采用向后选择的多变量逐步逻辑回归分析显示,基线东部肿瘤协作组表现状态(ECOG-PS)评分较低(1 分和 2 分)(比值比(OR),5.098;95%置信区间(CI),1.045-24.879,p=0.021)和基线血小板计数低于 18.8×10/µL(OR,3.861;95%CI,1.211-12.311,p=0.022)是影响 FN 发生率的显著因素。我们的研究结果表明,ECOG-PS 1-2 和较低的基线血小板计数是 NSCLC 患者接受多西他赛为基础的化疗发生 FN 的显著危险因素。此外,抗 VEGF 抗体和多西他赛的联合可能与 FN 频率增加相关。尽管该研究存在一些局限性,包括回顾性设计、单中心和小样本量,但基线 ECOG-PS 评分和血小板计数可能被视为在接受多西他赛为基础的化疗之前识别需要预防性使用粒细胞集落刺激因子(G-CSF)治疗的患者的重要指标。

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