Department of Pharmacy, Osaka Metropolitan University Hospital, Osaka, Japan.
Division of Social Pharmacy, Faculty of Pharmacy, Kindai University, Osaka, Japan.
Oncology. 2024;102(7):565-573. doi: 10.1159/000535822. Epub 2023 Dec 29.
Febrile neutropenia (FN) is an oncologic emergency requiring immediate empiric antibiotic therapy. Although carboplatin plus etoposide combination chemotherapy is associated with a relatively high frequency of FN, the risk factors are unclear. Hence, this retrospective study aimed to identify predictive markers of carboplatin/etoposide-induced FN.
We conducted a retrospective cohort analysis of patients with previously untreated small-cell lung cancer (SCLC) who received combination chemotherapy with carboplatin (area under the concentration curve: 5 mg/mL·min, day 1) and etoposide (80 or 100 mg/m2, days 1-3) between July 2007 and June 2022. FN was assessed during the 21 days after initiation of carboplatin and etoposide therapy according to the Japanese Society of Medical Oncology's definition. Fisher's exact test for categorical variables and Mann-Whitney U test for continuous variables were used to compare the two groups. Statistical significance was set at p values <0.05. Explanatory variables with p values <0.05 in the univariate analysis were included in the multivariate logistic regression analysis.
Among the 176 eligible patients, the incidence of FN during the first cycle of chemotherapy was 25.0% (44/176). Multivariate analysis revealed that co-administration of proton pump inhibitors (PPIs) or potassium-competitive acid blockers (PCABs) and body mass index (BMI) were significantly associated with FN (p = 0.0035 and 0.0011, respectively). Patients with both co-administration of PPIs or PCABs and a BMI ≤22.509 kg/m2 presented with significantly higher frequencies of FN compared with the other patients (13/24 [54.2%] vs. 31/152 [20.4%] patients; odds ratio: 4.56, 95% confidence interval: 1.70-12.48; p = 0.00147).
Patients who received carboplatin plus etoposide for SCLC with co-administration of PPIs or PCABs and a BMI ≤22.509 kg/m2 more frequently present with FN than those without the two factors.
发热性中性粒细胞减少症（FN）是一种需要立即进行经验性抗生素治疗的肿瘤急症。尽管卡铂联合依托泊苷联合化疗与 FN 的发生频率相对较高有关，但风险因素尚不清楚。因此，本回顾性研究旨在确定卡铂/依托泊苷引起 FN 的预测标志物。
我们对 2007 年 7 月至 2022 年 6 月期间接受卡铂（浓度曲线下面积：5mg/mL·min，第 1 天）和依托泊苷（80 或 100mg/m2，第 1-3 天）联合化疗的未经治疗的小细胞肺癌（SCLC）患者进行了回顾性队列分析。根据日本肿瘤学会的定义，在卡铂和依托泊苷治疗开始后 21 天内评估 FN。使用 Fisher 确切检验比较分类变量，使用 Mann-Whitney U 检验比较连续变量。统计学意义设定为 p 值 <0.05。单因素分析中 p 值 <0.05 的解释变量被纳入多因素逻辑回归分析。
在 176 名合格患者中，第 1 周期化疗时 FN 的发生率为 25.0%（44/176）。多因素分析显示，质子泵抑制剂（PPIs）或钾竞争性酸阻滞剂（PCABs）联合使用和体重指数（BMI）与 FN 显著相关（p=0.0035 和 0.0011）。同时使用 PPI 或 PCABs 且 BMI≤22.509kg/m2 的患者 FN 发生率明显高于其他患者（13/24[54.2%] vs. 31/152[20.4%]患者；比值比：4.56，95%置信区间：1.70-12.48；p=0.00147）。
接受卡铂联合依托泊苷治疗 SCLC 的患者同时使用 PPI 或 PCABs 且 BMI≤22.509kg/m2 时，FN 的发生率高于无这两个因素的患者。
