Objective. There exists limited information in the medical literature regarding the incidence and severity of
carboplatin-associated
neutropenia, outside the setting of a clinical trial. We wished to examine this issue in a large single institution experience involving patients receiving both single agent and combination
carboplatin-based
chemotherapy for management of a female pelvic
malignancy. Patients and methods. The medical records of women with gynecologic
cancers treated with
carboplatin-based
chemotherapy at the Cleveland Clinic from January 1, 1998 through December 31, 2002 were retrospectively reviewed to determine the incidence and severity of
neutropenia. Results. During the time period encompassed by this analysis, a total of 323 patients received 2145 cycles of
carboplatin-based
chemotherapy (total of 441 courses; median cycles/patient: 6 [range 1-27]). The total number of each program utilized, and the incidence of grades 3 and 4
neutropenia observed (lowest nadir/regimen), were as follows: single agent
carboplatin (178 courses; 5% grade 3, and <1% grade 4),
carboplatin/
paclitaxel (198; 23% and 6%),
carboplatin/
docetaxel (42; 17% and 73%) and
carboplatin/
paclitaxel/
irinotecan (23; 39% and 61%).
Febrile neutropenia was uncommon, and there was only a single neutropenic-related death. Conclusion. Both single-agent
carboplatin and
carboplatin/
paclitaxel result in a very low incidence of grade 4
neutropenia. While combining
docetaxel with
carboplatin or adding a "third drug" to
carboplatin/
paclitaxel substantially increases the incidence of severe
neutropenia, neutropenic
fever, and required hospitalizations for septic episodes are uncommon. The prophylactic
oral administration of a broad-spectrum
antibiotic (e.g., ciprofloxicin) in the presence of grade 4
neutropenia appears to be an effective strategy to minimize the risk of subsequent febrile events.