Prevention of docetaxel‐associated febrile neutropenia with primary granulocyte colony‐stimulating factor in Chinese metastatic hormone‐sensitive and castration‐resistant prostate cancer patients

Abstract

IntroductionAsian prostate cancer (PC) patients are particularly susceptible to docetaxel‐related febrile neutropenia (FN). We evaluated primary granulocyte colony‐stimulating factor (GCSF) for preventing FN in Chinese patients with metastatic hormone‐sensitive PC (mHSPC) and castration‐resistant PC (mCRPC).Patients and MethodsData from two cohorts of 377 Chinese patients with mHSPC (100; 26.5%) and mCRPC (277; 73.5%) treated with docetaxel at six public oncology centres were analysed with multivariate regression. Primary GCSF prophylaxis was defined as administration within 5 days of starting docetaxel. The primary outcome was FN within 21 days of the first docetaxel cycle (1st FN).ResultsPrimary GCSF was given to 71 (18.8%) patients. FN occurred in 61 patients (16.2%) including 37 (9.8%) during the first cycle. Among patients who developed 1st cycle FN (n = 37) or not (n = 340), 2 and 69 received primary GCSF (5.4 vs. 20.3%, P = .03). Primary GCSF was associated with an overall reduced risk of 1st cycle FN (odds ratio [OR] = 0.22; 95% confidence interval [CI]: 0.05‐0.96, P = .04), and similar trends were observed in the mHSPC (OR = 0.36, P = .35) and mCRPC (OR = 0.16, P = .08) subgroups. Poor Eastern Cooperative Oncology Group performance status (>1) was associated with an increased risk of 1st FN (OR = 3.90; 95% CI: 1.66‐9.13, P = .002).ConclusionsTo alleviate the risk of docetaxel‐related FN, primary GCSF prophylaxis is suggested for Asian mCRPC and mHSPC patients, particularly those with poor performance status.

Does castration status affect docetaxel‐related adverse events? :Identification of risk factors for docetaxel‐related adverse events in metastatic prostate cancer

“…In addition, we found that poor PS is an independent risk factor of FN, in line with a recent study from Asia 31 . In general, such comorbid patients are expected to have a high incidence of chemotherapy‐induced AEs 32 .…”

“…Finally, the incidence rates of FN, as well as neutropenia in our study, were higher compared with the previous literature 3,7,20,21 . The high incidence rates of neutropenia and FN have been noted in Asian patients 27,31,35,36 . Thus, the generalizability of our results to non‐Asian patients is limited.…”

“…3,7,20,21 The high incidence rates of neutropenia and FN have been noted in Asian patients. 27,31,35,36 Thus, the generalizability of our results to non-Asian patients is limited. Further prospective, well-designed studies are warranted.…”

“…In addition, we found that poor PS is an independent risk factor of FN, in line with a recent study from Asia. 31 In general, such comorbid patients are expected to have a high incidence of chemotherapy-induced AEs. 32 In addition, polypharmacy involving CYP3A4 inhibitors and substrates was also reported to increase the risk of docetaxel-related FN.…”

Ethnic Pharmacogenomic Differences in the Management of Asian Patients with Metastatic Prostate Cancer

“…On behalf of the Hong Kong Society of Uro-Oncology (HKSUO), our team reviewed the incidence of docetaxel-related haematological toxicities in mPC patients treated in six public oncology centres in Hong Kong [ 50 ]. Among 377 Chinese patients who received docetaxel, the overall incidence of FN was 15%; those with mCRPC had a higher incidence (17%) compared with that in the mHSPC patients (12%).…”