Risk Factors for Thrombocytopenia Induced by Capecitabine Plus Oxaliplatin Therapy in Patients With Colorectal Cancer.

BACKGROUND/AIM: Capecitabine plus oxaliplatin (CapeOX) therapy is used as an adjuvant chemotherapy regimen for patients with colorectal cancer (CRC). Although oxaliplatin induces thrombocytopenia, the risk factors for thrombocytopenia in oxaliplatin-treated patients with CRC are not well established. We aimed to investigate the risk factors for thrombocytopenia in CapeOX-treated patients with CRC. In addition, we evaluated platelet counts and non-invasive liver fibrosis indices, specifically the aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 index (FIB-4), during CapeOX therapy in these patients. PATIENTS AND METHODS: Between July 2017 and June 2020, we enrolled CapeOX-treated patients with high-risk stage II or stage III CRC at seven hospitals collaborating with the Division of Oncology, Aichi Prefectural Society of Hospital Pharmacists (Aichi prefecture, Japan). In this retrospective study, we investigated patients' backgrounds, laboratory data, concomitant medications, number of cycles of CapeOX and oxaliplatin, cumulative dose of oxaliplatin, and administration period. The cut-off values were calculated using receiver operating characteristic analysis of platelet counts and APRI and FIB-4 scores. RESULTS: Fifty-five patients without thrombocytopenia and 44 patients with thrombocytopenia were enrolled. During CapeOX therapy, the thrombocytopenia group showed a significant decrease in platelet count and a significant increase in APRI and FIB-4 scores compared to the non-thrombocytopenia group. Baseline albumin level ≤3.5 g/dl and platelet count ≤238×103/µl were independently associated with ≥grade 2 thrombocytopenia in CapeOX-treated patients. CONCLUSION: Baseline albumin level and platelet count may be useful for predicting thrombocytopenia in CapeOX-treated patients with high-risk stage II or stage III CRC.

[The Role of Pharmacists in AST in Large Hospitals and Their Training].

Since 1997, Chubu Rosai Hospital has been establishing the proper use of various antibacterial drugs through the activities of an infection control team (ICT), introduction of a notification system for specific antibacterial drug use, and intervention of ward pharmacists for individual cases. There is no infectious disease department, and we have been working closely with each other on multiple occupations. As an initiative, we established the Nagoya Southern Infection Countermeasures Meeting in 2006 and conducted antimicrobial use and resistance (AUR) surveys to promote the proper use of antimicrobial agents within the area. In April 2018, we formed an antimicrobial stewardship team (AST) and initiated activities. In addition, an AST pharmacist can share the AST results with the ward pharmacist, for proper use of antibacterial drugs and for early monitoring of infectious disease treatment and appropriate intervention, thus improving the efficiency of the ward pharmacist's work. This program will also lead to the development of training programs for the younger generation of pharmacists.