Chemotherapy‐induced neutropenia predicts short‐term outcome of patients with pancreatic cancer treated with nanoliposomal irinotecan, fluorouracil, and folinic acid

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Abstract Chemotherapy‐induced neutropenia has been identified as a potential prognostic marker for multiple cancers. However, only one retrospective study, NN‐2301, has investigated the relationship between neutropenia and treatment effects of nanoliposomal irinotecan/5‐fluorouracil/folinic acid (NFF) in pancreatic cancer. In this prospective study, we aimed to clarify whether NFF‐induced neutropenia could serve as a prognostic marker in pancreatic cancer. Data were analyzed from the prospective cohort of the NAPOLEON‐2 trial, an observational study involving patients with unresectable pancreatic cancer treated with NFF. Neutropenia severity was categorized into three cutoffs: Cutoff A (Grade [Gr] 0 vs. Gr 1–4), cutoff B (Gr 0–1 vs. Gr 2–4), and Cutoff C (Gr 0–2 vs. Gr 3–4), using the Common Terminology Criteria for Adverse Events version 5.0, owing to conformity with previous studies and simplicity. The primary endpoint was overall survival (OS); progression‐free survival (PFS) was the secondary endpoint. The neutropenic groups included Gr 1, 2, 3, and 4, with 79, 23, 34, and 7 patients, respectively. At each cutoff, OS and PFS were significantly better in the severe neutropenia groups. Higher neutropenia grades correlated with improved OS (log‐rank trend test: χ 2 = 8.62, p < .01). Multivariate Cox regression analysis revealed significant differences for all cutoffs: adjusted hazard ratios were 0.57 (95% confidence interval [CI] 0.40–0.83) (Cutoff A), 0.53 (95% CI 0.36–0.78) (Cutoff B), and 0.52 (95% CI 0.34–0.80) (Cutoff C). NFF‐induced neutropenia is a valuable prognostic marker in pancreatic cancer and may guide treatment selection.

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