Impact of chemotherapy-induced neutropenia on survival in patients with breast, ovarian and cervical cancer: a systematic review

Abstract

Background: Recent advances in chemotherapy administration, including targeted therapies and dose-dense scheduling have led to an increased incidence of neutropenia.  Chemotherapy-induced neutropenia has been shown to be associated with improved treatment outcomes in various solid tumor types. We looked to summarize the relationship between chemotherapy-induced neutropenia and survival in patients with breast, ovarian and cervical cancer and describe future directions of research.

Methodology/Principle Findings: A comprehensive PUBMED literature search was conducted using the key words “solid tumor,” “breast cancer,” “ovarian cancer,” “cervical cancer,” “endometrial cancer,” in combination with “chemotherapy,” “neutropenia,” “survival,” “disease recurrence,” and “prognosis.”  The search was also guided through a review of the reference lists of original and review articles. Published papers included in the review met the following criteria: patients with breast, ovarian, endometrial or cervical cancer treated with chemotherapy; prospective and retrospective studies, both randomized and cohort designs, evaluating impact of neutropenia or leukopenia on disease outcome.  Eleven studies met the inclusion criteria.  Sample size ranged from 103-750 subjects. The majority of included studies were conducted in breast cancer patients (7 of 11). No studies related to endometrial cancer were identified.  Outcome measures included overall survival, progression free survival and distant disease free survival.  All studies were retrospective in nature.  Of the 11 identified studies, 9 suggested that the occurrence of chemotherapy-induced neutropenia was associated with improvement in oncologic outcome.

Conclusions/Significance: Evaluation of the impact of chemotherapy-induced neutropenia on outcomes in patients with breast, ovarian and cervical cancer is warranted utilizing prospectively collected data from patients enrolled in clinical trials.