Impact of Polymorphisms on Febrile Neutropenia in Pancreatic Cancer Patients Receiving FOLFIRINOX: A Single-Center Cohort Study.

FOLFIRINOX (oxaliplatin, leucovorin, irinotecan, and 5-fluorouracil) is a first-line chemotherapy for metastatic pancreatic cancer (PC). Chemotherapy-induced neutropenia is one of the most serious adverse events associated with advanced PC. Although polymorphisms are associated with the metabolism of irinotecan, their role as surrogate markers for FOLFIRINOX-induced neutropenia has not been confirmed. We investigated risk factors for FN-in particular, polymorphisms-in PC patients receiving FOLFIRINOX, using a single-center cohort registry. To investigate the association between polymorphisms and FN, we divided patients into three groups based on the predicted phenotype: extensive metabolizer (EM) vs. intermediate metabolizer (IM) vs. poor metabolizer (PM). A total of 154 patients (FN group ( = 31) vs. non-FN group ( = 123)) receiving first-line FOLFIRINOX were identified between December 2017 and July 2020. The Cox regression analysis showed that female sex (HR: 2.20; = 0.031), Eastern Cooperative Oncology Group performance status = 1 (HR: 2.83; = 0.008), IM (HR: 4.30; = 0.004), and PM (HR: 4.03; = 0.028) were statistically significant risk factors for FN. We propose that is the strongest predictive factor for FN and that this gene should be screened prior to the administration of chemotherapy.