Impact of baseline and nadir neutrophil index in non-small cell lung cancer and ovarian cancer patients: Assessment of chemotherapy for resolution of unfavourable neutrophilia

Andreas Carus, Howard Gurney, Val Gebski, Paul Harnett, Rina Hui, Richard Kefford, Nicholas Wilcken, Morten Ladekarl, Hans von der Maase, Frede Donskov

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: Chronic inflammation has been recognized to foster tumour development. Whether chemotherapy can be used to neutralize chronic inflammation is unclear.

METHODS: We evaluated baseline and nadir neutrophils in 111 patients (pts.) with non-small cell lung cancer (NSCLC) and 118 pts. with ovarian cancer (OC) treated with chemotherapy administered with dose-individualization to achieve nadir neutropenia of 1.5. We used predefined baseline neutrophil cut-offs 4.5 × 109/L (NSCLC) and 3.9 × 109/L (OC).

RESULTS: Absence of chemotherapy-induced nadir neutropenia (CTCAE grade 0, neutrophils ≥ LLN) was seen in 23% of OC and 25% of NSCLC pts. Absence of nadir neutropenia was associated with decreased overall survival (OS) compared with presence (>grade 0) of neutropenia (9 vs. 14 months, P=0.004 for NSCLC and 23 vs. 56 months; P=0.01 for OC). Obtaining grade 3/4 neutropenia did not improve survival compared with grade 1/2 neutropenia. In multivariate analyses, baseline neutrophils ≥ 4.5 × 109/L (HR: 2.0; 95% CI: 1.11-3.44;P = 0.02) and absence of nadir neutropenia (HR: 1.6; 95% CI: 1.02-2.65;P = 0.04) for NSCLC and absence of nadir neutropenia (HR: 1.7; 95% CI: 1.04;2.93;P = 0.04) for OC were independently associated with short OS.

CONCLUSIONS: A neutrophil index comprising elevated baseline neutrophils and absence of neutropenia identified a high risk group of NSCLC and ovarian cancer patients with only modest effect of chemotherapy. New treatment options for this subset of patients are required.

LanguageEnglish
Pages189
Number of pages1
JournalJournal of Translational Medicine
Volume11
DOIs
Publication statusPublished - 2013

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Chemotherapy
Neutropenia
Non-Small Cell Lung Carcinoma
Ovarian Neoplasms
Neutrophils
Cells
Drug Therapy
Tumors
Survival
Inflammation
Multivariate Analysis

Cite this

Carus, Andreas ; Gurney, Howard ; Gebski, Val ; Harnett, Paul ; Hui, Rina ; Kefford, Richard ; Wilcken, Nicholas ; Ladekarl, Morten ; von der Maase, Hans ; Donskov, Frede. / Impact of baseline and nadir neutrophil index in non-small cell lung cancer and ovarian cancer patients : Assessment of chemotherapy for resolution of unfavourable neutrophilia. In: Journal of Translational Medicine. 2013 ; Vol. 11. pp. 189.
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title = "Impact of baseline and nadir neutrophil index in non-small cell lung cancer and ovarian cancer patients: Assessment of chemotherapy for resolution of unfavourable neutrophilia",
abstract = "BACKGROUND: Chronic inflammation has been recognized to foster tumour development. Whether chemotherapy can be used to neutralize chronic inflammation is unclear.METHODS: We evaluated baseline and nadir neutrophils in 111 patients (pts.) with non-small cell lung cancer (NSCLC) and 118 pts. with ovarian cancer (OC) treated with chemotherapy administered with dose-individualization to achieve nadir neutropenia of 1.5. We used predefined baseline neutrophil cut-offs 4.5 × 109/L (NSCLC) and 3.9 × 109/L (OC).RESULTS: Absence of chemotherapy-induced nadir neutropenia (CTCAE grade 0, neutrophils ≥ LLN) was seen in 23{\%} of OC and 25{\%} of NSCLC pts. Absence of nadir neutropenia was associated with decreased overall survival (OS) compared with presence (>grade 0) of neutropenia (9 vs. 14 months, P=0.004 for NSCLC and 23 vs. 56 months; P=0.01 for OC). Obtaining grade 3/4 neutropenia did not improve survival compared with grade 1/2 neutropenia. In multivariate analyses, baseline neutrophils ≥ 4.5 × 109/L (HR: 2.0; 95{\%} CI: 1.11-3.44;P = 0.02) and absence of nadir neutropenia (HR: 1.6; 95{\%} CI: 1.02-2.65;P = 0.04) for NSCLC and absence of nadir neutropenia (HR: 1.7; 95{\%} CI: 1.04;2.93;P = 0.04) for OC were independently associated with short OS.CONCLUSIONS: A neutrophil index comprising elevated baseline neutrophils and absence of neutropenia identified a high risk group of NSCLC and ovarian cancer patients with only modest effect of chemotherapy. New treatment options for this subset of patients are required.",
author = "Andreas Carus and Howard Gurney and Val Gebski and Paul Harnett and Rina Hui and Richard Kefford and Nicholas Wilcken and Morten Ladekarl and {von der Maase}, Hans and Frede Donskov",
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Impact of baseline and nadir neutrophil index in non-small cell lung cancer and ovarian cancer patients : Assessment of chemotherapy for resolution of unfavourable neutrophilia. / Carus, Andreas; Gurney, Howard; Gebski, Val; Harnett, Paul; Hui, Rina; Kefford, Richard; Wilcken, Nicholas; Ladekarl, Morten; von der Maase, Hans; Donskov, Frede.

In: Journal of Translational Medicine, Vol. 11, 2013, p. 189.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Impact of baseline and nadir neutrophil index in non-small cell lung cancer and ovarian cancer patients

T2 - Journal of Translational Medicine

AU - Carus, Andreas

AU - Gurney, Howard

AU - Gebski, Val

AU - Harnett, Paul

AU - Hui, Rina

AU - Kefford, Richard

AU - Wilcken, Nicholas

AU - Ladekarl, Morten

AU - von der Maase, Hans

AU - Donskov, Frede

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Chronic inflammation has been recognized to foster tumour development. Whether chemotherapy can be used to neutralize chronic inflammation is unclear.METHODS: We evaluated baseline and nadir neutrophils in 111 patients (pts.) with non-small cell lung cancer (NSCLC) and 118 pts. with ovarian cancer (OC) treated with chemotherapy administered with dose-individualization to achieve nadir neutropenia of 1.5. We used predefined baseline neutrophil cut-offs 4.5 × 109/L (NSCLC) and 3.9 × 109/L (OC).RESULTS: Absence of chemotherapy-induced nadir neutropenia (CTCAE grade 0, neutrophils ≥ LLN) was seen in 23% of OC and 25% of NSCLC pts. Absence of nadir neutropenia was associated with decreased overall survival (OS) compared with presence (>grade 0) of neutropenia (9 vs. 14 months, P=0.004 for NSCLC and 23 vs. 56 months; P=0.01 for OC). Obtaining grade 3/4 neutropenia did not improve survival compared with grade 1/2 neutropenia. In multivariate analyses, baseline neutrophils ≥ 4.5 × 109/L (HR: 2.0; 95% CI: 1.11-3.44;P = 0.02) and absence of nadir neutropenia (HR: 1.6; 95% CI: 1.02-2.65;P = 0.04) for NSCLC and absence of nadir neutropenia (HR: 1.7; 95% CI: 1.04;2.93;P = 0.04) for OC were independently associated with short OS.CONCLUSIONS: A neutrophil index comprising elevated baseline neutrophils and absence of neutropenia identified a high risk group of NSCLC and ovarian cancer patients with only modest effect of chemotherapy. New treatment options for this subset of patients are required.

AB - BACKGROUND: Chronic inflammation has been recognized to foster tumour development. Whether chemotherapy can be used to neutralize chronic inflammation is unclear.METHODS: We evaluated baseline and nadir neutrophils in 111 patients (pts.) with non-small cell lung cancer (NSCLC) and 118 pts. with ovarian cancer (OC) treated with chemotherapy administered with dose-individualization to achieve nadir neutropenia of 1.5. We used predefined baseline neutrophil cut-offs 4.5 × 109/L (NSCLC) and 3.9 × 109/L (OC).RESULTS: Absence of chemotherapy-induced nadir neutropenia (CTCAE grade 0, neutrophils ≥ LLN) was seen in 23% of OC and 25% of NSCLC pts. Absence of nadir neutropenia was associated with decreased overall survival (OS) compared with presence (>grade 0) of neutropenia (9 vs. 14 months, P=0.004 for NSCLC and 23 vs. 56 months; P=0.01 for OC). Obtaining grade 3/4 neutropenia did not improve survival compared with grade 1/2 neutropenia. In multivariate analyses, baseline neutrophils ≥ 4.5 × 109/L (HR: 2.0; 95% CI: 1.11-3.44;P = 0.02) and absence of nadir neutropenia (HR: 1.6; 95% CI: 1.02-2.65;P = 0.04) for NSCLC and absence of nadir neutropenia (HR: 1.7; 95% CI: 1.04;2.93;P = 0.04) for OC were independently associated with short OS.CONCLUSIONS: A neutrophil index comprising elevated baseline neutrophils and absence of neutropenia identified a high risk group of NSCLC and ovarian cancer patients with only modest effect of chemotherapy. New treatment options for this subset of patients are required.

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