Irinotecan is effective for the treatment of metastatic
colorectal cancer (mCRC) and advanced
pancreatic cancer (aPC). However, these treatments are often limited due to the incidence of severe
neutropenia. We identified risk factors for severe
neutropenia in patients with mCRC or aPC, receiving
irinotecan-based
chemotherapy regimens. The study selected 104 patients (mCRC: 53 and aPC: 51) who received
irinotecan-based
chemotherapy between January 2014 and May 2018 and who were included in the present study. The initial dose of
irinotecan was 150 mg/m2 in all patients, and patients with a lower initial dose of
irinotecan were excluded. Severe
neutropenia (grade ≥ 3) occurred in 56 patients (53.8%). Multivariable Cox proportional hazards analysis indicated that modified
FOLFIRINOX (mFOLFIRINOX) and serum total
bilirubin (T-Bil) were significant risk factors for severe
neutropenia. Moreover, with receiver-operating characteristic (ROC) curve analysis, the cutoff for T-Bil was found to be 0.7 mg/dL. Among patients treated with mFOLFIRINOX
therapy, the incidence of severe
neutropenia was significantly higher in patients with high level of T-Bil (> 0.7 mg/dL) than in those without it (93.8% vs 55.0%, P = 0.006). A
chemotherapy regimen (modified
FOLFIRINOX therapy) and T-Bil > 0.7 mg/dL were significant risk factors for severe
neutropenia in patients receiving 150 mg/m2
irinotecan.