Myelotoxicity and Dose Intensity of Chemotherapy: Reporting Practices From Randomized Clinical Trials

Authors:
David C. Dale From Department of Medicine, University of Washington, Seattle, WA; Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA; Divisions of Oncology and Hematology, Duke University Medical Center, Durham, NC; and University of Rochester Medical Center, Rochester, NY.

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Gordon C. McCarter From Department of Medicine, University of Washington, Seattle, WA; Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA; Divisions of Oncology and Hematology, Duke University Medical Center, Durham, NC; and University of Rochester Medical Center, Rochester, NY.

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Jeffrey Crawford From Department of Medicine, University of Washington, Seattle, WA; Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA; Divisions of Oncology and Hematology, Duke University Medical Center, Durham, NC; and University of Rochester Medical Center, Rochester, NY.

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Gary H. Lyman From Department of Medicine, University of Washington, Seattle, WA; Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA; Divisions of Oncology and Hematology, Duke University Medical Center, Durham, NC; and University of Rochester Medical Center, Rochester, NY.

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Volume/Issue:
Volume 1: Issue 3
Online Publication Date:
Jul 2003
DOI:
https://doi.org/10.6004/jnccn.2003.0038
Full access

Delivery of cancer chemotherapy is often limited by myelotoxicity, primarily neutropenia. As part of an effort to create a model to predict the risk of chemotherapy-induced neutropenia, we reviewed the reports of randomized clinical trials with more than 50 patients per arm in early-stage breast cancer (ESBC) and non-Hodgkin's lymphoma (NHL) published between 1990 and 2000. We observed that no hematologic toxicity data were reported in 39% and 34% of the ESBC and NHL trials, respectively. The remaining trials reported on hematologic toxicity in 16 different ways. When reported, rates of neutropenia, leukopenia, and hematotoxicity varied widely with the same and similar chemotherapy regimens. Dose-intensity data were not reported in 39% and 54% of ESBC and NHL trials, respectively. The majority of the remaining studies reported incomplete dose-intensity data such as percentages of patients completing all cycles or receiving a given percentage of planned dose intensity. Only 28% reported the mean or median relative dose intensity received by patients. Based on this review, we conclude that current practices for reporting chemotherapy treatments are inadequate for describing the risk of chemotherapy to patients or for quantitatively assessing the risk of treatment alternatives. We recommend that standard procedures for documenting and reporting hematologic toxicity and dose intensity in cancer chemotherapy trials be required for publication of chemotherapy trials.

Correspondence: David Dale, MD, University of Washington, Department of Medicine, Box 356422, HSB, Room AA522, 1959 NE Pacific, Seattle, WA 98195-6422. E-mail: dcdale@u.washington.edu
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Copyright:
Copyright © 2003 by the National Comprehensive Cancer Network 2003
Page Numbers:
15
Article Category:
Research Article
Received:
21 Dec 2002
Accepted:
16 Apr 2003
Print Publication Date:
01 Jul 2003
Online Publication Date:
Jul 2003
Keywords:
Chemotherapy; myelotoxicity; neutropenia; relative dose intensity; supportive care
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