Pretherapeutic Inflammation Predicts Febrile Neutropenia and Reduced Progression-Free Survival after First-Line Chemotherapy in SCLC

Abstract

Background: Despite initial response to chemotherapy, the prognosis of small cell lung cancer (SCLC) patients is limited. Following first-line therapy, the strongest predictor of durable progression-free survival (PFS) is remission quality. Febrile neutropenia (FN) is a frequent complication after chemotherapy, and its prevention could improve treatment density and degree of remission. Patients and Methods: We retrospectively analyzed 39 SCLC patients treated at a German tertiary care lung cancer center between 2013 and 2016. We extracted data sets from electronic records and analyzed anthropometric data, pretherapeutic blood values, and prognostic scores. Discriminant analysis was performed to predict FN. Results: PFS after first-line chemotherapy was significantly shorter in patients with FN (p = 0.003). Pretherapeutic albumin (p = 0.019), C-reactive protein (CRP; p < 0.001), lactate dehydrogenase (p = 0.041), neutrophil-to-lymphocyte ratio (p = 0.009), prognostic nutritional index (p = 0.018), and Glasgow prognostic score (p < 0.001) were significantly associated with FN. CRP in combination with absolute neutrophil count is a strong predictor of FN (positive predictive value 79.8%). Conclusion: SCLC patients with FN after chemotherapy showed significantly reduced PFS. Prevention of FN may improve treatment results. We identified pretherapeutic markers which can predict FN risk. This simple and cost-effective method could serve to identify the need for preventive measures against FN (e.g., prophylactic antibiotic treatment or granulocyte colony stimulating factor administration).

Hyperinflation and reduced diffusing capacity predict prognosis in SCLC: value of extended pre-therapeutic lung function testing

“…Several prognostic factors have been identified in the last decades including high levels of lactate dehydrogenase (LDH) 3,4 and inflammatory markers. 5–7 The major risk factor for SCLC development is smoking, 2 which is on the other hand also a risk factor for the development of chronic obstructive pulmonary disease (COPD). Therefore, COPD seems to be clearly linked to the development of SCLC, 8 but until now there is no strong evidence that this comorbidity affects prognosis in SCLC patients.…”

Is there any room for PD-1 inhibitors in combination with platinum-based chemotherapy as frontline treatment of extensive-stage small cell lung cancer? A systematic review and meta-analysis with indirect comparisons among subgroups and landmark survival analyses

“… 3 For decades, platinum-doublet chemotherapy (CT) has represented the standard of care for ES-SCLC patients, resulting in only transient radiographic response and clinical improvement together with limited survival rates. 4 , 5 Unfortunately, after poor outcomes and decades of failed clinical research, the overall survival (OS) rate has not increased significantly. 6 Despite rapid United States (US) Food and Drug Administration (FDA) approval of immuno-oncology (IO) agents as monotherapy in later settings, 7 the standard first-line treatment approach has been relatively unchanged for three decades.…”

Glasgow prognostic score for prediction of chemotherapy‐triggered acute exacerbation interstitial lung disease in patients with small cell lung cancer

“…28 After its introduction, GPS was reported to be a reproducible predictor of long-term prognosis for NSCLC and SCLC. [29][30][31][32][33][34][35][36][37][38] However, there have been no previous studies examining the relationship between GPS and SCLC with concomitant ILD in patients undergoing chemotherapy. Therefore, the purpose of this study was to determine whether GPS predicts prognosis and chemotherapy-triggered AE-ILD in patients with SCLC and concomitant ILD.…”