BOSTONResearchers from the Awareness of Neutropenia in Chemotherapy (ANC) Study Group report that older cancer patients are at greater risk of death due to chemotherapy-related febrile neutropenia. They recommend that the elderly receive prophylactic colony-stimulating factors (CSFs) as adjuncts to CHOP and CHOP-like chemotherapy regimens.
The group’s findings, presented at the third meeting of the International Society of Geriatric Oncology (SIOG), were based on two studies: a retrospective analysis of more than 55,000 episodes of febrile neutropenia (abstract P-25) and a review of 11 randomized CHOP trials from which data could be extracted for older patients (abstract O-7B-02).
The ANC Study Group receives support from Amgen Inc. of Thousand Oaks, California, which manufactures the CSFs filgrastim(Drug information on filgrastim) (Neupogen) and pegfilgrastim (Neulasta).
The first study reviewed discharge information for adult, nontransplant patients admitted with febrile neutropenia from 1995 to 2000 at 115 teaching hospitals in the University HealthSystem Consortium (UHC) database. Jeffrey Crawford, MD, director of clinical research, Duke University Comprehensive Cancer Center, and his colleagues reported that patients age 65 and older accounted for 27% of admissions for febrile neutropenia but 36% of inpatient deaths.
The researchers found 55,276 episodes of febrile neutropenia in 41,779 patients during this 6-year period. More than 14,000 episodes occurred in patients age 65 or older.
The large number surprised the investigators, Dr. Crawford said. "I think this has to do with the lack of appreciation of the magnitude of this problem," he told ONI, suggesting that many oncologists don’t recognize how frequently neutropenia occurs or how much it interferes with treatment.
"Unfortunately, our strategy for altering chemotherapy doses or adding CSF support is more reactive than proactive," he added. "The data speak to that. We’re getting thousands of admissions per year in these 115 institutions of patients over 65. We’re clearly not identifying these patients well enough prospectively."