Chemotherapy-induced neutropenia (CIN)
regimens — and
When CIN strikes, it negatively affects the therapy regimen you have carefully planned for your patients. Not only are optimal outcomes compromised, but dose disruptions and delays are also very likely to occur. These interruptions are likely to translate into decreased survival and increased mortality.3
The 4 Ds: How CIN may negatively affect treatment2:
CIN not only compromises your patient’s immune system and opens them to the threat of devastating infection, but it also wreaks havoc on your planned treatment regimen, potentially forcing you to:
the recommended dose
the prescribed regimen
The consequences of disrupted treatment by CIN
Maintaining full doses and dosing schedules is critical for survival. But CIN is relentless. One of its most insidious effects may be its disruption of treatment and the potentially serious consequences it creates on overall survival. As treatment is compromised, so are your patient’s immune defense mechanisms, increasing their risk of infection.2,4-6
What you can do right now
Be aware of the Neutropenia Vulnerability Gap
As early as Day 8 in Cycle 1, patients become highly vulnerable to life-threatening events as a result of ANC levels dropping. Timely recognition of the absolute neutrophil “low point” (ANC nadir) and prevention of infection can reduce hospitalizations and treatment delays.5,7
Expert Perspectives in CIN
Dr. Lyman: The impact of modifications in the chemotherapy dose and schedule of course vary with type of cancer, the stage of cancer, the data supporting the cancer therapies, the chemotherapy regimens for those cancers. So, there is a variation across cancer types and regimens. However, again, when treating for curative intent, early stage disease, it’s very clear that the data that we and others have generated clearly shows that if you substantially, and I’m talking as little as perhaps 10%, 15% reduce the dose intensity of chemotherapy in those settings, you end up with a measurable and clinically significant increase in the risk of cancer recurrence.
I continue to emphasize to my trainees, again, you may start off and do what you think is a relatively minor reduction in the dose to alleviate the risk in some patients or delay treatment a week because of a holiday or something coming up. But when you look across the whole course of the therapy, those small, some appearing to be modest or minimal reductions in dose intensity, add up. And by the end of the patient’s treatment course, you end up realizing, actually, I’ve really significantly reduced the dose intensity of that therapy.
You get one shot at this, generally. I mean, some—certainly some patients with responsive cancers can come back in and get second-line therapy and still go on to do well. But the best chance for a treatable, responsive cancer to be cured is that first course of therapy.
- Lyman GH. Management of chemotherapy-induced neutropenia with colony-stimulating factors. Eur Oncol. 2008;4(2):13-17.
- Lyman GH. Impact of chemotherapy dose intensity on cancer patient outcomes. J Natl Compr Canc Netw. 2009;7(1):99-108.
- Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004;100(2):228-237.
- Halpern MT, Yabroff KR. Prevalence of outpatient cancer treatment in the United States: estimates from the Medical Panel Expenditures Survey (MEPS). Cancer Invest. 2008;26(6):647-651.
- Gupta A, Abbasi B, Gupta S. Management of chemotherapy induced neutropenia—an unmet clinical need. Am J Biomed Sci & Res. 2019;4(5):313-318.
- Chirivella I, Bermejo B, Insa A, et al. Optimal delivery of anthracycline-based chemotherapy in the adjuvant setting improves the outcome of breast cancer patients. Breast Cancer Res Treat. 2009;114(3):479-484.
- Cheng C, Gallagher EM, Yeh JY, Earl MA. Rates of febrile neutropenia with pegfilgrastim on same day versus next day of CHOP with or without rituximab. Anticancer Drugs. 2014;25(8):964-969.