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Japanese Journal of Clinical Oncology Advance Access published online on May 30, 2007
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hym033
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© 2007 Foundation for Promotion of Cancer Research

Serum Total Bilirubin as a Predictive Factor for Severe Neutropenia in Lung Cancer Patients Treated with Cisplatin and Irinotecan

Yutaka Fujiwara, Ikuo Sekine, Yuichiro Ohe, Hideo Kunitoh, Noboru Yamamoto, Hiroshi Nokihara, Yuko Simmyo, Tomoya Fukui, Kazuhiko Yamada and Tomohide Tamura

Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo, Japan

For reprints and all correspondence: Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo 104-0045, Japan. E-mail: isekine{at}ncc.go.jp

Received September 29, 2006; accepted January 5, 2007

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.

Key Words: irinotecan • toxicity • lung cancer


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