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Severe Neutropenia May Predict Survival Outcomes in Patients With Pancreatic Cancer

David Bai, PharmD
Among patients with pancreatic cancer being treated with modified FOLFIRINOX, those who develop severe neutropenia have significantly longer median overall survival, as well as longer time to treatment failure, compared with those who do not develop severe neutropenia.
Severe neutropenia is associated with longer overall survival (OS) in patients with pancreatic cancer who receive modified FOLFIRINOX therapy, according to the results of new study.

Pancreatic cancer is the fourth leading cause of cancer-related mortality in the world, mainly due to its late diagnosis. In patients who are diagnosed at the latter stages, chemotherapy is usually the standard of treatment. FOLFIRINOX, a combination of oxaliplatin, irinotecan, 5-flurouracil, and leucovorin, is a chemotherapy regimen that has been shown to significantly prolong survival in patients with advanced pancreatic cancer. Even though FOLFIRINOX is effective, it is also very toxic, with higher incidence rates of diarrhea and neutropenia compared with other treatments.

Modified FOLFIRINOX is a regimen that reduces the doses in the FOLFIRINOX regimen to mitigate the occurrence of adverse events. Although a decrease in adverse events is beneficial to enhance a patient’s quality of life, some studies have identified that patients with more severe neutropenia have actually survived longer. In order to confirm if the incidence of severe neutropenia is related to OS in patients with pancreatic cancer, researchers compared the survival outcomes of patients with and without severe neutropenia.

Among the 51 patients enrolled to receive modified FOLFIRINOX, 39 (76.5%) of them developed severe (grade 3 or higher) neutropenia. Patients who developed severe neutropenia had significantly longer median OS compared with patients who did not (21.3 months vs 8.9 months; P = .02). These patients also had longer time to treatment failure than those without severe neutropenia (7.0 months vs 3.7 months; P = .079).

One-year survival rates and tumor response rates also favored patients with severe neutropenia (71.8% vs 41.7%; P = .085, 35.9% vs 16.7%; P = .296, respectively). Disease control rates followed a similar relationship, with 76.9% of patients with severe neutropenia achieving either complete remission, partial response, or stable disease, compared with 66.7% of patients without severe neutropenia (P = .474).   

Although most of the findings observed were not significant, investigators concluded that there was an undeniable relationship between survival and the incidence of severe neutropenia in patients with pancreatic cancer treated with modified FOLFIRINOX. Use of the incidence of severe neutropenia may serve as an indicator of survival outcomes for these patients who receive modified FOLFIRINOX.


Yamada Y, Fujii H, Watanabe D, et al. Severe neutropenia is associated with better clinical outcomes in patients with advanced pancreatic cancer who receive modified FOLFIRINOX therapy. Cancers (Basel). 2018;10(11):pii: E454. doi: 10.3390/cancers10110454.

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