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Risk of febrile neutropenia and early treatment cessation in men receiving standard and dose‐reduced 3‐weekly docetaxel for metastatic castration‐resistant prostate cancer
Author(s) -
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.
Publication year - 2018
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12840
Subject(s) - docetaxel , medicine , prostate cancer , febrile neutropenia , neutropenia , hazard ratio , toxicity , oncology , chemotherapy , surgery , cancer , confidence interval
Background 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. Methods 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/m 2 vs LD≤60 mg/m 2 ) 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. Results 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). Conclusions 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.