title: Serum total bilirubin as a predictive factor for severe neutropenia in lung cancer patients treated with cisplatin and irinotecan.
abstract: OBJECTIVE
  To clarify the association between pre-treatment total bilirubin (PTB) level and severe toxicity in patients receiving cisplatin and irinotecan.
  
  
  METHODS
  We analyzed retrospectively the relationships of grade 4 neutropenia or grade 3-4 diarrhea and clinical variables including PTB and pre-treatment neutrophil counts (PNC) using a logistic regression model.
  
  
  RESULTS
  One hundred and twenty-seven patients (93 men, 34 women; median age: 61 years; range: 24-74 years) received cisplatin (60 or 80 mg/m2) on day 1 and irinotecan (60 mg/m2) on days 1 and 8 every 3 weeks or on days 1, 8 and 15 every 4 weeks. Grade 4 neutropenia occurred in 29 patients (23%) and grade 3-4 diarrhea occurred in 13 patients (10%). Grade 4 neutropenia was associated with a higher PTB level (odds ratio: 4.9; 95% confidence interval: 1.4-17.7), a higher cisplatin dose (2.8, 1.0-7.8) and a lower PNC (1.5, 1.0-2.3). Grade 3-4 diarrhea was associated with liver metastasis (11.2, 2.2-57.4), a higher cisplatin dose (5.0, 1.2-21.3) and a lower PNC (2.0, 1.1-3.6).
  
  
  CONCLUSIONS
  PTB level was associated with the severity of neutropenia caused by cisplatin and irinotecan.
authors.affiliation: Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Ikuo
authors.initials: I
authors.lastname: Sekine
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ohe
authors.forename: Hideo
authors.initials: H
authors.lastname: Kunitoh
authors.forename: Noboru
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nokihara
authors.forename: Yuko
authors.initials: Y
authors.lastname: Simmyo
authors.forename: Tomoya
authors.initials: T
authors.lastname: Fukui
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yamada
authors.forename: Tomohide
authors.initials: T
authors.lastname: Tamura
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000633:toxicity; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000633:toxicity; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000633:toxicity*; D001663:Bilirubin / Q000097:blood*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000633:toxicity; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D000077146:Irinotecan; D002945:Cisplatin; D001663:Bilirubin; D002166:Camptothecin