Chemotherapy-induced neutropenia as a prognostic factor in patients with advanced non-small cell lung cancer treated with front-line docetaxel-gemcitabine chemotherapy.

ABSTRACT

BACKGROUND: Front-line docetaxel-gemcitabine (DG) combination represents an alternative to platinum-based chemotherapy in patients with advanced NSCLC. One of its more common side effects is neutropenia. The association between the grade of DG-induced neutropenia and the clinical outcome was analyzed. PATIENTS AND METHODS: Eight hundred fifty-eight patients with locally advanced/metastatic NSCLC, treated with front-line DG were retrospectively analyzed. Patients were categorized into three groups according to the presented worst neutropenia grade absent (grade 0), mild (grades I/II) and severe (grades III/IV). RESULTS: Response rate, median time to tumor progression (TTP) and median overall survival (OS) were significantly better in patients developing any grade of neutropenia compared with those without neutropenia. The median TTPs were 3.0, 5.4 and 5.6 months for the groups with absent, mild and severe neutropenia, respectively; the median OSs were 7.9, 12.5 and 11.2 months for the same groups, respectively. Multivariate analysis revealed that both mild and severe chemotherapy-induced neutropenia were independent factors associated with a better TTP and OS survival. CONCLUSION: Although DG-induced neutropenia was emerged as an independent prognostic factor, it remains to be demonstrated in prospective studies that dose escalation of chemotherapy drugs in patients who do not develop neutropenia may improve the clinical efficacy.