Department of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 4-1, Maeda 7-Jo 15-Chome, Teine-Ku, Sapporo, 006-8585, Japan.
Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan.
Support Care Cancer. 2024 Nov 27;32(12):829. doi: 10.1007/s00520-024-09006-z.
Carboplatin (CBDCA) plus pemetrexed (PEM) is a commonly-used thoracic cancer treatment. As both CBDCA and PEM are excreted via the kidneys, renal impairment (RI) can lead to severe neutropenia, the most typical adverse event in the treatment. We aimed to determine the impact of baseline RI on the development of severe neutropenia following real-world CBDCA + PEM-containing treatments.
Patients with thoracic cancer receiving CBDCA + PEM-containing treatments (n = 155) were divided into a control group (baseline creatinine clearance [CCr] ≥ 60 mL/min) and an RI group (baseline CCr < 60 mL/min) and retrospectively evaluated. The primary endpoint was the incidence of severe neutropenia during the first cycle. We also assessed factors associated with the development of severe neutropenia.
Severe neutropenia during the first cycle was confirmed in 41.2% of the patients in the RI group, which was significantly higher than that in the control group (20.7%, P = 0.02). Additionally, severe neutropenia during all evaluation periods was also more prevalent in the RI group compared to the control group (47.1% vs. 24.8%, P = 0.02). In contrast, the incidence of severe thrombocytopenia was not different. Multivariate logistic regression analyses identified RI as a risk factor for severe neutropenia (adjusted odds ratio 2.71; 95% confidence interval 1.18-6.21, P = 0.02 for the first cycle; 2.62, 1.17-5.84, P = 0.02 for all evaluation periods).
Our study revealed that patients with baseline RI exhibited severe neutropenia after CBDCA + PEM-containing treatments.
卡铂（CBDCA）联合培美曲塞（PEM）是一种常用的胸部癌症治疗方法。由于 CBDCA 和 PEM 均通过肾脏排泄，因此肾功能损害（RI）可导致严重的中性粒细胞减少症，这是该治疗中最典型的不良反应。我们旨在确定基线 RI 对真实世界中 CBDCA+PEM 联合治疗后严重中性粒细胞减少症的发展的影响。
接受 CBDCA+PEM 联合治疗的胸部癌症患者（n=155）分为对照组（基线肌酐清除率[CCr]≥60 mL/min）和 RI 组（基线 CCr<60 mL/min），并进行回顾性评估。主要终点是第一个周期中严重中性粒细胞减少症的发生率。我们还评估了与严重中性粒细胞减少症发展相关的因素。
RI 组中有 41.2%的患者在第一个周期中出现严重中性粒细胞减少症，明显高于对照组（20.7%，P=0.02）。此外，RI 组在所有评估期内严重中性粒细胞减少症的发生率也明显高于对照组（47.1% vs. 24.8%，P=0.02）。相比之下，严重血小板减少症的发生率没有差异。多变量逻辑回归分析确定 RI 是严重中性粒细胞减少症的危险因素（调整后的优势比 2.71；95%置信区间 1.18-6.21，P=0.02 用于第一个周期；2.62，1.17-5.84，P=0.02 用于所有评估期）。
我们的研究表明，基线 RI 的患者在接受 CBDCA+PEM 联合治疗后会出现严重的中性粒细胞减少症。
