Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical Research
  • Published:

Febrile neutropenia (FN) rates in metastatic hormone sensitive prostate cancer: the role of antibiotics as primary prophylaxis

Prostate Cancer and Prostatic Diseases volume 24, pages 166–168 (2021)Cite this article

Subjects

The STAMPEDE and CHAARTED trials established docetaxel as first-line treatment alongside androgen deprivation therapy (ADT) in patients with metastatic hormone-sensitive prostate cancer (mHSPC). However, this treatment regimen is associated with a considerable risk of febrile neutropenia (FN). The CHAARTED trial reported FN rates of 6% [1] whereas STAMPEDE demonstrated an FN rate of 15% [2]. Both were significantly higher than the rate of 3% exhibited in the castrate-resistant setting [3]. Real-world studies have demonstrated FN occurrences up to 30% [4,5,6], prompting calls to use granulocyte colony stimulating factor (GCSF) as primary FN prophylaxis; which is costly and associated with a range of side effects.

We investigated the effectiveness of prophylactic fluoroquinolones as primary FN prophylaxis in mHSPC. We concurrently explored the contribution of maintenance prednisolone to FN, as steroids are immunosuppressive [7] and the treatment regimens in the two landmark trials differed in the use of maintenance prednisolone.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Cumulative incidence plot showing proportion of patients who experienced febrile neutropenia after each cycle of treatment.

References

  1. Sweeney CJ, Chen YH, Carducci M, Liu G, Jarrard DF, Eisenberger M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015;373:737–46.

    Article  CAS  Google Scholar 

  2. James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, Spears MR, 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. Lancet. 2016;387:1163–77.

    Article  CAS  Google Scholar 

  3. Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351:1502–12.

    Article  CAS  Google Scholar 

  4. Rulach RJ, McKay S, Neilson S, White L, Wallace J, Carruthers R, et al. Real-world uptake, safety profile and outcomes of docetaxel in newly diagnosed metastatic prostate cancer. BJU Int. 2018;121:268–74.

    Article  CAS  Google Scholar 

  5. Tsao CK, Galsky MD, Oh WK. Docetaxel for metastatic hormone-sensitive prostate cancer: urgent need to minimize the risk of neutropenic fever. Eur Urol. 2016;70:707–8.

    Article  Google Scholar 

  6. Mahil J, Hughes C, Patel K, Lyons J, Elliott PA, Choudhury A, et al. Febrile neutropenia rates in men treated with docetaxel chemotherapy for metastatic hormone-sensitive prostate cancer. Clin Oncol (R Coll Radio). 2016;28:612.

    Article  CAS  Google Scholar 

  7. Auphan N, DiDonato JA, Rosette C, Helmberg A, Karin M. Immunosuppression by glucocorticoids: inhibition of NF-kappa B activity through induction of I kappa B synthesis. Science. 1995;270:286–90.

    Article  CAS  Google Scholar 

  8. Fernandes R, Mazzarello S, Stober C, Vandermeer L, Dudani S, Ibrahim MF, et al. Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: a systematic review. Breast Cancer Res Treat. 2017;161:1–10.

    Article  CAS  Google Scholar 

  9. Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, et al. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Oncol. 2019;20:1760–72.

    Article  CAS  Google Scholar 

  10. Leibovici L, Paul M, Cullen M, Bucaneve G, Gafter-Gvili A, Fraser A, et al. Antibiotic prophylaxis in neutropenic patients: new evidence, practical decisions. Cancer. 2006;107:1743–51.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the expert contributions received during the presentation of this work at the 16th British Uro-Oncology Group Annual Meeting, particularly Professor Amit Bahl and Professor Robert Jones.

Author information

Author notes

  1. These authors contributed equally: Lara Pemberton, Kenrick Ng

  2. These authors jointly supervised this work: Constantine Alifrangis, Jonathan Shamash

Authors and Affiliations

  1. Department of Medical Oncology, Barnet General Hospital, Barnet, UK

    Lara Pemberton & Ursula McGovern

  2. Department of Medical Oncology, St Bartholomew’s Hospital, London, UK

    Kenrick Ng, Alan Macdonald, Myria Galazi, Peter Wilson, Paula Wells, Constantine Alifrangis & Jonathan Shamash

  3. Department of Medical Oncology, University College London Hospital, London, UK

    Kenrick Ng, Ursula McGovern, Hasti Barot, Myria Galazi, Mark Linch & Constantine Alifrangis

Authors
  1. Lara Pemberton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenrick Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ursula McGovern
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alan Macdonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hasti Barot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Myria Galazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paula Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mark Linch
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Constantine Alifrangis
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jonathan Shamash
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and Design: Constantine Alifrangis, Jonathan Shamash, Kenrick Ng, Paula Wells, Ursula McGovern, Mark Linch. Data Acquisition: Lara Pemberton, Kenrick Ng, Alan Macdonald, Hasti Barot, Myria Galazi. Data Analysis and Interpretation: Lara Pemberton, Kenrick Ng, Alan Macdonald, Myria Galazi, Constantine Alifrangis, Ursula McGovern, Jonathan Shamash. Drafting Manuscript: Lara Pemberton, Kenrick Ng. Statistical Analysis: Kenrick Ng, Peter Wilson.

Corresponding author

Correspondence to Kenrick Ng.

Ethics declarations

Conflict of interest

KN has received honoraria from Boehringer Ingelheim and GSK/TESARO. He has also received travel/accommodation expenses from GSK/TESARO and research funding from Cancer Research UK (Award Number 549580). ML has received research funding from Bristol-Myers Squibb, AstraZeneca/MedImmune, Sanofi and Astellas and has received consulting fees from Janssen Pharmaceuticals and BioNTech. The other authors declare no conflicts of interest.

Informed consent

All authors consent for publication.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pemberton, L., Ng, K., McGovern, U. et al. Febrile neutropenia (FN) rates in metastatic hormone sensitive prostate cancer: the role of antibiotics as primary prophylaxis. Prostate Cancer Prostatic Dis 24, 166–168 (2021). https://doi.org/10.1038/s41391-020-0261-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-020-0261-z

Search

Advanced search

Quick links