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. 2025 Jun;16(11):e70099.
doi: 10.1111/1759-7714.70099.

Association Between Baseline Neutrophil Count and Febrile Neutropenia Following Docetaxel and Ramucirumab With Prophylactic Pegfilgrastim

Tomonori Makiguchi  1 , Haruka Odagiri  1 , Hisashi Tanaka  1 , Kageaki Taima  1 , Sadatomo Tasaka  1
Affiliations

Association Between Baseline Neutrophil Count and Febrile Neutropenia Following Docetaxel and Ramucirumab With Prophylactic Pegfilgrastim

Tomonori Makiguchi et al. Thorac Cancer. 2025 Jun.

Abstract

Background: Patients with non-small cell lung cancer (NSCLC) receiving docetaxel (DTX) and ramucirumab (RAM) regimen frequently experience febrile neutropenia (FN). We aimed to clarify the incidence rate and predictive factors of FN under prophylactic pegfilgrastim.

Methods: Fifty-four patients with NSCLC received DTX + RAM from 2018 to 2023 in our hospital. Age, gender, performance status (PS), treatment line, prior thoracic irradiation, body mass index (BMI), neutrophil count at baseline (BNC) and the lowest neutrophil count (LNC), serum albumin, and incidence of FN were recorded. The correlation between BNC and LNC was analyzed. We evaluated the association between BNC and FN using logistic regression analysis. The baseline characteristics of two groups stratified by the cutoff BNC using the ROC curve were compared.

Results: All the patients received prophylactic pegfilgrastim. Three (5.5%) patients experienced FN. There was a significant correlation between BNC and LNC (rs = 0.43, p = 0.0003). BNC and cardiovascular disease were significantly associated with FN (odds ratio 0.998, p = 0.0151 and odds ratio 28.64, p = 0.034). The receiver operating characteristic curve showed the cutoff value of BNC was 3000/μL (AUC 0.88). There was no significant difference in other baseline characteristics between the patients with BNC of 3000/μL or more and those with BNC less than 3000/μL.

Conclusion: Our data showed the incidence rate of FN receiving DTX + RAM with prophylactic pegfilgrastim was 5.5%. Despite prophylactic pegfilgrastim, BNC was correlated with LNC and might be predictive of FN. We should be careful of BNC even if it meets the criteria for starting DTX + RAM treatment.

Keywords: baseline neutrophil count; docetaxel; febrile neutropenia; pegfilgrastim; ramucirumab.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Consort diagram. Fifty‐eight patients received docetaxel and ramucirumab regimen. Of these, four patients were excluded because of poor performance status. All the patients received prophylactic pegfilgrastim. Finally, 54 patients were recruited. DTX, docetacel; PS: performance status; RAM, ramucirumab.
FIGURE 2
FIGURE 2
The correlation between the baseline neutrophil count and the lowest neutrophil count. X‐axis and Y‐axis indicate the baseline neutrophil count (×103/μL) and the lowest neutrophil count, respectively. r s : correlation coefficient.
FIGURE 3
FIGURE 3
Receiver operating characteristic curve of the baseline neutrophil count associated with the onset of febrile neutropenia. X‐axis and Y‐axis indicate 1‐specificity and sensitivity, respectively. AUC, area under curve; CI, confidence interval. Solid circle indicates the point at which the AUC is highest.
See this image and copyright information in PMC

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