Detection of risk factors related to administration suspension and severe neutropenia in gemcitabine and nab-paclitaxel treatment

• Published in: Supportive care in cancer 2021-06, Vol.29 (6), p.3277-3285
• Main Authors: Saito, Yoshitaka, Takekuma, Yoh, Kobayashi, Masaki, Komatsu, Yoshito, Sugawara, Mitsuru
• Format: Article
• Language: English
• Subjects: Albumin; Antimitotic agents; Antineoplastic agents; Cancer; Chemotherapy; Cytotoxicity; Drug administration; Health risks; Infection; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Metastasis; Neutropenia; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Palonosetron; Pancreatic cancer; Rehabilitation Medicine; Risk factors; Side effects
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-020-05842-x

Purpose The combination of gemcitabine (GEM) and nanoparticle albumin-bound paclitaxel (nab-PTX) is an effective chemotherapeutic regimen for locally advanced and metastatic pancreatic cancer. The dose-limiting toxicities (DLTs) of this treatment are sepsis and neutropenia, while the relative dose intensity (RDI) of GEM is approximately 75% and of nab-PTX is 70–80%. In this study, we evaluated the risk factor(s) regarding treatment suspension, which leads to reduction in the RDI of these agents, enabling appropriate schedule management. Methods Two hundred patients with pancreatic cancer who received GEM + nab-PTX were retrospectively investigated. Frequency and risk factor(s) of suspension of the treatment and grade 3/4 neutropenia in the first course were evaluated. Results The frequency of treatment suspension in the first course was 61%. The frequency of grade 3/4 neutropenia was 51%, while that of thrombocytopenia was 7.5%. The RDI was 78.0% for GEM and 77.7% for nab-PTX. Univariate and multivariate analyses to identify risk or preventive factors related to treatment suspension suggested that low platelet count at baseline was a risk factor, whereas dose reduction from the treatment initiation was a preventive factor. The most common cause of abeyance was grade 3/4 neutropenia (83.6%), the risk factors of which were low platelet count and age ≥ 65 years at baseline, while dose reduction was a preventive factor. Conclusion We found that a low platelet level at baseline was a risk factor, whereas dose reduction from initiation was a preventive factor in regard to treatment suspension and severe neutropenia occurrence in GEM + nab-PTX treatment.