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Risk of febrile neutropenia in patients receiving emerging chemotherapy regimens

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Abstract

Purpose

Considerable evidence exists concerning the risk of febrile neutropenia (FN) associated with well-established, older chemotherapy regimens. Little is known, however, about the risks associated with many regimens that were introduced in the past decade and have become the predominant choice for certain cohorts of patients or are increasingly being used in clinical practice.

Methods

A retrospective cohort design and US healthcare claims data (2006–2011) were employed. Study subjects included adult patients receiving the following: docetaxel + cyclophosphamide (TC), 5-FU + epirubicin + cyclophosphamide (FEC), FEC followed by docetaxel (FEC → D), or docetaxel + carboplatin + trastuzumab (TCH) for non-metastatic breast cancer; TCH for metastatic breast cancer; 5-FU + leucovorin + irinotecan + oxaliplatin (FOLFIRINOX) for metastatic pancreatic cancer; and bendamustine (with rituximab [BR], without rituximab [B-Mono]) for non-Hodgkin’s lymphoma (NHL). For each patient, the first qualifying chemotherapy course and each cycle therein were identified, as were the use of supportive care—colony-stimulating factors (CSF) and antimicrobials (AMB)—and unique FN episodes.

Results

The crude risk (incidence proportion) of FN during the chemotherapy course ranged from 8.8 (95 % CI 8.3–9.3) to 10.6 % (9.3–12.1) among the breast cancer regimens, was slightly higher for the NHL regimens (BR, 10.5 % [8.9–12.4]; B-Mono, 14.7 % [11.2–18.9]), and was markedly higher for FOLFIRINOX (24.7 % [17.9–33.1]). Most patients developing FN required inpatient care (range, 73–90 %). Use of CSF primary prophylaxis ranged from 17 (B-Mono) to 75 % (FEC → D); use of AMB primary prophylaxis ranged from 6 (FOLFIRINOX) to 13 % (B-Mono).

Conclusion

The risk of FN among patients receiving selected emerging chemotherapy regimens is considerable, and most cases require inpatient care. Use of CSF and AMB prophylaxis, however, varies substantially across regimens.

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Declaration of funding

Funding for this research was provided by Amgen Inc. to Policy Analysis Inc. (PAI).

Declaration of financial/other relationships

Derek Weycker, John Edelsberg, and Alex Kartashov are employed by PAI. Xiaoyan Li, Rich Barron, and Hairong Xu are employed by Amgen Inc. Gary Lyman is a principal investigator on a research grant from Amgen Inc. to Duke University.

Authors’ contributions

Authorship was designated based on the guidelines promulgated by the International Committee of Medical Journal Editors (2004). All persons who meet criteria for authorship are listed as authors on the title page. The contribution of each of these individuals to this study—by task—is as follows: conception and supervision (Li and Weycker), development of design (all authors), conduct of analyses (Kartashov, Weycker), interpretation of results (all authors), preparation of manuscript (Edelsberg, Weycker), and review of manuscript (all authors). All authors have read and approved the final version of the manuscript. The study sponsor reviewed the study research plan and study manuscript; data management, processing, and analyses were conducted by PAI, and all final analytic decisions were made by study investigators.

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Authors and Affiliations

  1. Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA

    Derek Weycker, John Edelsberg & Alex Kartashov

  2. Amgen Inc., Thousand Oaks, CA, USA

    Xiaoyan Li, Rich Barron & Hairong Xu

  3. Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Gary H. Lyman

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  1. Derek Weycker
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  7. Gary H. Lyman
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Correspondence to Derek Weycker.

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Weycker, D., Li, X., Edelsberg, J. et al. Risk of febrile neutropenia in patients receiving emerging chemotherapy regimens. Support Care Cancer 22, 3275–3285 (2014). https://doi.org/10.1007/s00520-014-2362-5

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  • DOI: https://doi.org/10.1007/s00520-014-2362-5

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