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Title: Risk of febrile neutropenia and early treatment cessation in men receiving standard and dose-reduced 3-weekly docetaxel for metastatic castration-resistant prostate cancer.
Austin Authors: Hamid, Anis A;Willson, Kaspar;Vincent, Andrew D;Tamjid, Babak ;Lee, Margaret;Bergin, Alice;Gan, Chun;Campbell, Ainsley ;Stewart, Josephine;Pezaro, Carmel;Tran, Ben;Weickhardt, Andrew J 
Affiliation: Olivia Newton-John Cancer Wellness and Research Center, Austin Health, Heidelberg, Victoria, Australia
Freemasons Foundation Center for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Eastern Health and Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
Epworth Freemasons, East Melbourne, Victoria, Australia
Royal Melbourne Hospital, Parkville, Victoria, Australia
Peter MacCallum Cancer Center, Victorian Comprehensive Cancer Center, Parkville, Victoria, Australia
Issue Date: Oct-2018 2018-01-10
Publication information: Asia-Pacific journal of clinical oncology 2018; 14(5): e399-e404
Abstract: Docetaxel is an effective therapy for metastatic castration-resistant prostate cancer (mCRPC); however, many patients experience febrile neutropenia (FN) and cease treatment early due to toxicity. It is not known whether lower dose (LD) q3-weekly docetaxel impacts toxicity or efficacy. Multicenter retrospective study included 166 patients with mCRPC who received q3-weekly docetaxel between 2010 and 2015. Demographic, disease, chemotherapy (standard dose, SD>60 mg/m2vs LD≤60 mg/m2) and toxicity data were collected. Univariable and multivariable logistic and competing risk regression models evaluated docetaxel-dose association with FN and early treatment cessation (ETC) due to toxicity. Associations between dose and efficacy end points were also evaluated. Analyses were repeated employing inverse propensity score weights. Patients who received LD docetaxel (28.9%) were older with poorer Eastern Cooperative Oncology Group (ECOG) status. Fifteen percent of patients experienced FN, with a nonsignificant trend to lower incidence in the LD group (multiple adjusted odds ratio [OR] = 0.42; P = 0.21). Neither baseline patient nor prior treatment factors were predictive of FN. ETC due to toxicity occurred in 35%, with risk associated with increasing age, comorbidity count and poorer ECOG. There was no difference between LD and SD with respect to ETC due to toxicity, in unweighted and weighted analyses (LD vs SD, multivariable weighted hazard ratio [HR] = 1.47; P = 0.08). LD was associated with reduced prostate-specific antigen (PSA) response (50% vs 66.1%, multivariable weighted HR = 0.54; P = 0.03) and overall survival (median 7.9 vs 13.8 months, multivariable weighted HR = 2.19; P < 0.0001). LD docetaxel for mCRPC did not mitigate the risk of FN or ETC due to toxicity. Dose reduction may result in poorer PSA response and survival.
DOI: 10.1111/ajco.12840
ORCID: 0000-0002-7193-9723
PubMed URL: 29318740
Type: Journal Article
Subjects: castration resistant
chemotherapy toxicity
febrile neutropenia
metastatic Prostate cancer
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