Background: In some solid cancers a survival benefit has been observed for patients who had chemotherapy-induced neutropenia. The prognostic impact of baseline and nadir blood neutrophils was assessed in the present study. Methods: Data on patients with breast cancer st.I-IV, ovarian cancer st.I-IV, non-small cell lung cancer (NSCLC) st.II-IV, and small-cell lung cancer (SCLC) treated from 1997 to 2005 at Westmead Hospital, Sydney, with complete medical records of the first 3 cycles of chemotherapy and a full set of baseline and nadir laboratory data were collected from patient medical files.Survival data were updated 2010. Results: A total of 819 patients were identified, comprising 507 patients with breast cancer, 118 patients with ovarian cancer, 115 patients with NSCLC and 79 patients with SCLC. Median survival for ovarian cancer patients obtaining nadir neutropenia below 2.0 x 109/l was 56 months. In contrast, median survival for ovarian cancer patients who had nadir neutropenia above 2.0 was 27 months. In a multivariate analysis, adjusting for well-known prognostic features, nadir neutropenia below 2.0 was statistically significant (HR 1.73;p=0.03). In patients with NSCLC, baseline elevated neutrophil count was associated with short survival (p< 0.00001). The subgroup of NSCLC patients with baseline neutrophils above median value (5.9) had significantly improved survival if they obtained nadir neutropenia below 2.0 (median survival 13.4 vs 8.8 mo, p=0.041). On the contrary, in the subgroup of NSCLC patients with baseline neutrophils below median value, nadir neutropenia did not impact survival. Finally, no impact of nadir neutropenia on survival was observed for SCLC or breast cancer patients. Conclusions: Chemotherapy-induced nadir neutropenia was significantly associated with improved overall survival in patients with ovarian cancer and the subgroup of NSCLC with baseline elevated neutrophils, whereas no significant impact was observed in small cell lung cancer or breast cancer in this cohort of patients. The prognostic impact of nadir neutropenia in ovarian and non small cell lung cancer should be confirmed in larger prospective trials.
Journal of Clinical Oncology, 2011, Vol 29, Issue Supplement
Main Research Area:
American Society of Clinical Oncology (ASCO) Annual Meeting 2011