Febrile Neutropenic Episodes in Men Treated with Docetaxel Chemotherapy for Metastatic Hormone-Sensitive Prostate Cancer (MHSPC)

An audit to assess rates of febrile neutropenia (FN) in men with metastatic hormone-sensitive prostate cancer treated with docetaxel chemotherapy.

Recent clinical trials proving the benefit of docetaxel chemotherapy in hormone-sensitive metastatic prostate cancer (HSMPC) have reported a greater risk of febrile neutropenia (FN) than seen in the castrate-resistant setting. STAMPEDE1 reported 15%, CHAARTED2 6% and GETUG-AFU153 7% grade 3-5 FN in comparison with Tax-3274 which showed 3% FN. Clinical experience at our centre suggested the risk of FN was higher than that experienced in these trials.

The standard: 

ASCO guidelines 2015⁵ state: “primary prophylaxis with a CSF starting with the first cycle and continuing through subsequent cycles of chemotherapy  is recommended in patients who have an approximately 20% or higher risk for FN based on patient-, disease- and treatment-related factors”.

Target: 

100% of men receiving docetaxel for HSMPC should receive primary prophlyaxis with GCSF if the FN rate is ≥20%.

Indicators: 

FN defined as fever >37.5 oC, ANC <1.0 requiring admission to hospital and IV antibiotics

Data items to be collected: 

Patient Demographics

WHO PS

Stage

Grade

Episode of FN

Use of GCSF

Dose Reductions

Cycles completed

Suggested number: 

50

Discuss at local drugs and therapeutics committee.

Adjust local protocols to include GCSF in prescription

Case Notes

Chemotherapy Prescriptions

1. James ND, Sydes MR, Clarke NW et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet 2016;387; 1163 - 1177 

2. Sweeney CJ, Chen YH, Carducci M et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. New Engl J Med 2015; 373; 737-46.

3. Gravis G, Fizazi K, Joly F et al. Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU15): a randomised, open-label, phase 3 trial. Lancet Oncol 2013; 14; 149-58.

4. Tannock IF, de Wit R, Berry WR et al.Docetaxel plus Prednisolone or Mitoxantrone plus Prednisolone for Advanced Prostate Cancer.  New Engl J Med 2004; 351; 1502-12.

5. Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the Use of WBC Growth Factors:American Society of Clinical Oncology Practice Guideline Update. J Clin Oncol 2015: 33: 3199 – 3212.

Dr Ruth Conroy

Co-authors

Dr A Choudhury

Dr PA Elliott

Dr J Mahil

Dr C Hughes

Miss J Lyons