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Does Older Age Lead to Higher Risk for Neutropenia in Patients Treated with Paclitaxel?

Marie-Rose B S Crombag, Stijn L W Koolen, Sophie Wijngaard, Markus Joerger, Thomas P C Dorlo, Nielka P Van Erp, Ron H J Mathijssen, Jos H Beijnen & Alwin D R Huitema

abstract

PURPOSE
There is ongoing concern regarding increased toxicity from paclitaxel in elderly patients, particularly of severe neutropenia. Yet, data so far is controversial and this concern is not supported by a clinically relevant age-dependent difference in pharmacokinetics (PK) of paclitaxel. This study assessed whether age is associated with increased risk for paclitaxel-induced neutropenia.

METHODS
Paclitaxel plasma concentration-time data, pooled from multiple different studies, was combined with available respective neutrophil count data during the first treatment cycle. Paclitaxel pharmacokinetic-pharmacodynamic (PK-PD) data was modeled using a non-linear mixed effects approach and a semiphysiological neutropenia model, where systemic paclitaxel exposure was linked to reduced proliferation of neutrophils. The impact of age was evaluated on relevant variables in the model, using a significance threshold of p < 0.005.

RESULTS
Paclitaxel PK-PD data was evaluated from 300 patients, with a median age of 65 years (range 23-84 years), containing 116 patients ≥70 years (39%). First cycle neutrophil counts were adequately described by a threshold effect model of paclitaxel on the proliferation rate of neutrophils. Age as a continuous or dichotomous variable (≥70 versus <70 years) did not significantly impact sensitivity of the bone marrow to paclitaxel nor the average maturation time of neutrophils (both p > 0.005), causing a decline in the respective interindividual variability of <1%.

CONCLUSION
Results from this large retrospective patient cohort do not suggest elderly patients to be at an increased risk of developing paclitaxel-associated neutropenia during the first treatment cycle. Reflexive dose reductions of paclitaxel in elderly patients are unlikely to improve the risk of severe neutropenia and may be deleterious.
   
citation Crombag M R B S, Koolen S L W, Wijngaard S, Joerger M, Dorlo T P C, Van Erp N P, Mathijssen R H J, Beijnen J H, Huitema A D R. Does Older Age Lead to Higher Risk for Neutropenia in Patients Treated with Paclitaxel?. Pharm Res 2019; 36:163.
   
type journal paper/review (English)
date of publishing 15-10-2019
journal title Pharm Res (36/12)
ISSN electronic 1573-904X
pages 163
PubMed 31617004
DOI 10.1007/s11095-019-2697-1