Neutropenia is one of the most important dose-limiting toxicities and often the reason for dose reduction. In this study we aimed to assess whether chemotherapy-induced neutropenia could be a marker of efficacy and associate with increased survival. Data from a retrospective survey for early breast cancer patients in our hospital were reviewed. Three hundred and thirty-five patients who had been treated with six cycles of cyclophosphamide, epirubicin, and fluorouracil (CEF) were studied. The association between chemotherapy-induced neutropenia and overall survival (OS) was assessed. According to a multivariate Cox model with time-varying covariates, hazard ratios of death were 0.434 (95% confidence interval (CI), 0.298-0.634; P < 0.001) for patients with mild neutropenia, and 0.640 (95% CI, 0.42-0.975; P = 0.038) for those with severe neutropenia. Neutropenia occurring in early breast cancer patients is an independent predictor of increased survival. These findings suggest that neutropenia in patients who receive chemotherapy is strongly associated with a better prognosis.

Abstract:Purpose: This meta-analysis investigated pemetrexed-based doublet compared with pemetrexed alone as second-line therapy for patients with advanced non-small cell lung cancer. Methods: Randomized controlled trials which compared pemetrexed-based doublet with single-agent pemetrexed in patients as second-line treatment of advanced non-small cell lung cancer were searched. Overall survival (OS) was the primary end point, while secondary end points included progression-free survival, overall response rate, 1-year survival rate, and grade 3 or 4 toxicity. Results: Four eligible randomized clinical trials including 1,084 patients were selected. Meta-analysis demonstrated that pemetrexed-based doublet arm signifi cantly improved the overall response rate (OR=2.70, 95% CI: 1.76-4.15, p=0.000), compared with docetaxel alone group, while there were no signifi cant differences in overall survival (HR=0.88, 95% CI: 0.74-1.04, p=0.132), progression-free survival (HR=0.91, 95% CI: 0.73-1.15, p=0.443), and 1-year survival rate (OR=1.43, 95% CI: 0.85-2.40, p=0.178) between the two arms. However, there were more frequencies of grade 3-4 leucopenia (OR=2.86, 95% CI: 1.32-6.20, p=0.008), neutropenia (OR=2.69, 95% CI: 1.55-4.68, p=0.000) and thrombocytopenia (OR=6.92, 95% CI: 2.51-19.07, p=0.000) in pemetrexed-based doublet group. Grade 3-4 anemia (OR=0.62, 95% CI: 0.33-1.18, p=0.144) and fatigue (OR=1.15, 95% CI: 0.73-1.79, p=0.550) had equivalent incidences in the two groups. Conclusions: This is the fi rst meta-analysis to compare pemetrexed-based doublet with single-agent pemetrexed in second-line therapy of non-small cell lung cancer. Our meta-analysis suggested that pemetrexed combination chemotherapy was not superior to single-agent arm and was not recommended as the second-line chemotherapy for patients with non-small cell lung cancer (Tab. 2, Fig. 6, Ref. 20). Text in PDF www.elis.sk. Key words: non-small-cell lung cancer, docetaxel, second-line therapy, meta-analysis. Lung cancer is one of the most common malignancies worldwide both in incidence and mortality, and leads in causing cancerrelated deaths throughout the world (1, 2). Non-small-cell lung cancer (NSCLC), including squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma accounts for approximately 80 % of all lung tumors, while 65-80 % of them present as local advanced or metastatic disease (3, 4). Less than 5 % of the fi ve-year survival rate is detected in stages IIIB and IV NSCLC patients (5). The treatment for local advanced or metastatic lung cancer is limited. Since surgical excision is impossible in most patients, chemotherapy remains the mainstay of treatment (2).For recurrent NSCLC patients, second-line chemotherapy is necessary. Docetaxel alone is the current standard for second-line treatment of advanced NSCLC, which can prolong survival after platinum-based chemotherapy (6, 7). However, in a randomized phase III trial, Nasser Hanna et al (8) compared the effi cacy and toxicity of pemetrexed versus docetaxel in advanced NSCLC patient...