Predictors of severe and febrile neutropenia during primary chemotherapy for ovarian cancer

ObjectiveTo identify factors that increase the risk of neutropenic events in women with advanced ovarian carcinoma receiving initial chemotherapy.MethodsMulti-center retrospective study of women with FIGO stage III–IV epithelial ovarian cancer treated postoperatively with multi-agent intravenous chemotherapy from 1995 to 2008. Outcomes were severe (SN; absolute neutrophil count [ANC] < 500/mm3) and febrile neutropenia (FN; ANC < 1000/mm3 and temperature > 38.1 °C). Cumulative risk of neutropenic events was estimated by Kaplan Meier method. Multivariate analysis was by Cox proportional hazard regression.ResultsThree hundred twenty-six patients met inclusion criteria. There were 251 SN events among 140 (43%) patients and 24 FN events among 22 (7%) patients. Univariate predictors of SN were body surface area < 2.0 m2 (p = 0.03), body mass index (BMI) < 30 kg/m2 (p < 0.01), Caucasian race (p < 0.01), treatment on research protocols (p < 0.01), non-carboplatin-containing regimens (p < 0.01), and planned relative dose intensity (RDI) > 85% of standard (p = 0.02). Women over age 60 were more likely to develop FN (p = 0.05). Multivariate predictors of SN were treatment on research protocols (hazard ratio [HR] 1.93; p < 0.01), Caucasian race (HR 2.13; p = 0.01), and planned RDI > 85% (HR 1.69; p = 0.05); predictors of FN were age > 60 (HR 2.84; p = 0.05) and non-carboplatin containing regimens (HR 4.06; p < 0.01).ConclusionWhile SN is fairly common, FN occurs infrequently in women with EOC undergoing taxane and platin-based chemotherapy and primary prophylactic growth factor support is not indicated. However, women older than 60 years of age receiving non-carboplatin containing regimens are at higher risk for FN and warrant closer surveillance.

► Women receiving standard intravenous chemotherapy for ovarian cancer have low risk for febrile neutropenia; prophylactic growth factors are not indicated.
► Women over 60 and those treated with non-standard regimens are at higher risk of febrile neutropenia and warrant close surveillance.