Nonneutropenic febrile episodes associated with docetaxel-based chemotherapy in patients with solid tumors.
BACKGROUND
Docetaxel is associated with severe lymphopenia and increased incidence of nonneutropenic infection. This study investigated the incidence of nonneutropenic infections and/or febrile episodes in patients with solid tumors receiving frontline docetaxel-based chemotherapy.


METHODS
Chemotherapy-naive patients with solid tumors treated with docetaxel-based chemotherapy were studied prospectively for the development of nonneutropenic infections.


RESULTS
During a 2-year period, 680 cancer patients enrolled in 24 protocols received 2867 cycles of docetaxel-containing chemotherapy. Fifty-three patients (7.8%) developed nonneutropenic infections and/or febrile episodes. The most common of these were pulmonary infections (n = 25), Pneumocystis carinii interstitial pneumonias (n = 5), and candidal (n =11), herpetic (n =4), and cytomegaloviral (n =3) infections. Thirty-six patients (68%) had severe lymphopenia (< 900 cells per deciliter) and 49 (92%) had less than 400 CD4(+) cells per deciliter. Patients with a low CD4(+) cell count (</= 200 cells per deciliter) had a significantly higher probability to develop opportunistic than common infections (P = 0.002). The incidence of nonneutropenic infections and/or febrile episodes was significantly higher in patients treated with docetaxel/gemcitabine (18.3%; P = 0.0001) and docetaxel/CDDP (11.7%; P = 0.012) than in those treated with docetaxel alone (3.6%). Conversely, 175 patients who received 752 cycles of chemotherapy with paclitaxel-containing regimens and 410 patients who received 2174 cycles with nontaxane-based regimens developed 6 (3.4%; p=0.042) and 12 (3%; p=0.001) nonneutropenic infections, respectively. Less than 10% of the patients of the two latter groups were lymphopenic. The risk of nonneutropenic infection in patients receiving docetaxel-based chemotherapy was 2.38 and 2.8 times higher than in patients receiving paclitaxel and nontaxane-based chemotherapy, respectively.


CONCLUSIONS
Patients treated with docetaxel-based chemotherapy are at increased risk of developing nonneutropenic infections. This may be related, at least partly, to severe postchemotherapy CD4(+) lymphopenia.
Souglakos
John
J
Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece.
Kotsakis
Athanaslos
A
Kouroussis
Charalambos
C
Kakolyris
Stylianos
S
Mavroudis
Dimitrios
D
Kalbakis
Konstadinos
K
Agelaki
Sofia
S
Vlachonikolis
John
J
Georgoulias
Vassilis
V
Samonis
George
G
D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols; D002177:Candidiasis / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000209:etiology; D000077143:Docetaxel; D005334:Fever / Q000139:chemically induced*; D006566:Herpesviridae Infections / Q000209:etiology; D006801:Humans; D007239:Infections / Q000209:etiology*; D008171:Lung Diseases / Q000209:etiology; D008231:Lymphopenia / Q000139:chemically induced; D009369:Neoplasms; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D011020:Pneumonia, Pneumocystis / Q000209:etiology; D011446:Prospective Studies; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000139:chemically induced; D043823:Taxoids
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel