Introduction
Neutropenia is a life-threatening and dose-limiting toxicity of palliative lung
cancer chemotherapy. Whilst some neutropenias are inevitable, evidence
suggests that patients with a previous neutropenic event are 50% more likely to
have a further neutropenic event. The aim of this research is to evaluate the
variables associated with the risk of secondary neutropenic events and the role
of chemotherapy dose reductions.
Methods
A retrospective analysis was carried out on 361 biochemical neutropenic events
in palliative lung cancer patients across 5 sites in South Yorkshire and
Bassetlaw. Predictors for a secondary neutropenic event were investigated in
univariate and multivariate logistic regression analysis. The predictive model
was validated through discrimination statistics, described by Receiver Operating
Characteristic Area Under Curve (ROC-AUC).
Results
The incident rate for secondary neutropenic events was 32.7%. Patients with a
successful intervention received a higher mean Relative Dose Intensity (RDI) of
75.65% compared to 65.05%, across the 2 chemotherapy cycles. The
univariate analysis found that the biochemical type of neutropenia (depth and length of suppression) (p=0.003), dose reduction of drug 1 (p=0.042), average dose reduction (p=0.019), and cumulative dose reduction (p=0.018) were
significant at reducing the risk of secondary neutropenia. Granulocyte-Colony
Stimulating Factor did not offer a protective effect. The final logistic regression
model evaluated 357 events and included all variables due to significant
interrelationship. The model had a ROC-AUC of 0.76 (0.71-0.81) (p= 0.0021),
explaining 27% of the variance.
Conclusion
Appropriate dose reductions play a vital role in preventing secondary
neutropenic events and delivering optimal RDIs. The results of this study can
aid in identifying high-risk patients.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/19262 |
| Date | January 2020 |
| Creators | Amini, Khuram M.A. |
| Contributors | Silcock, Jonathan, Gopalan, Rajendran C., Faisal, Muhammad |
| Publisher | University of Bradford, School of Pharmacy and Medical Sciences. Faculty of Life Sciences |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Thesis, doctoral, PhD |
| Rights | <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. |
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