Abstract
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. Cancer 2002;95:1326–33. © 2002 American Cancer Society.
DOI 10.1002/cncr.10802