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Antibiotic prophylaxis for febrile neutropenia in prostate cancer

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, the treatment is associated with a considerable risk of febrile neutropenia (FN).

Researchers at Barnet General Hospital, St Bartholomew’s Hospital, and University College London investigated the effectiveness of prophylactic fluoroquinolones as primary FN prophylaxis in mHSPC, and explored the contribution of maintenance prednisolone to FN.

Data from 159 mHSPC patients who commenced docetaxel chemotherapy between January 2015 and February 2018 were retrospectively collected. Cohort A (n=81) received up to six cycles of docetaxel 75 mg/m2 every 3 weeks alongside ADT + concomitant prednisolone 5 mg BD (STAMPEDE regimen). Cohort B (n=78) received docetaxel + ADT but without steroids (CHAARTED regimen) and with prophylactic ciprofloxacin 500 mg BD between days five and 15 of each cycle.

The rate of any grade 3/4 adverse event was 17.2% in cohort A and 12.8% in cohort B (P=0.57). The incidence of FN was significantly higher in cohort A, who received maintenance prednisolone and did not receive prophylactic antibiotics (14.8% vs 2.5%; P=0.006).

In cohort A, where 12 (14.8%) patients developed FN, the majority (75%) did so following cycle 1. Two-thirds (n=8; 66.7%) received 75 mg/m2 at their first cycle. Sixteen patients received prophylactic GCSF: three as primary prophylaxis and 13 as secondary prophylaxis. Of the 13 who received secondary prophylaxis, one did not have FN but was admitted with Klebsiella septicaemia after cycle 1.

In cohort B, two (2.5%) patients developed FN. Neither received prophylactic GCSF. The authors say this low incidence is likely to be a combined effect of prophylactic ciprofloxacin and omission of prednisolone.

The authors concluded that the addition of prophylactic ciprofloxacin and omission of maintenance prednisolone is associated with a decreased risk of developing FN.


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