Patients with early stage colorectal cancer can receive adjuvant FOLFOX (leucovorin, fluorouracil, oxaliplatin) chemotherapy despite having a low day-before absolute neutrophil count.1

Investigators sought to determine if FOLFOX administration to patients with early stage colorectal cancer had an effect on the incidence of chemotherapy-induced febrile neutropenia, received dose intensity, and chemotherapy delay. They also sought to determine if absolute neutrophil counts could predict neutropenia.

A retrospective chart review of 132 patients who received adjuvant chemotherapy for early stage colorectal cancer at a hospital in Toronto, Canada, between April 2005 and May 2014 was conducted. A total of 1074 cycles of chemotherapy were analyzed.

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Chemotherapy-induced febrile neutropenia occurred in 6 cases. A significant difference was found in the day-before absolute neutrophil counts between patients who developed chemotherapy-induced febrile neutropenia (1.4 × 109/L; 95% CI, 0.76 – 2.0 × 109/L) and those who did not (2.9 × 109/L; 95% CI, 2.8 – 3.0 × 109/L; P = .03).

Received dose intensity was 0.95 for oxaliplatin and 0.96 for 5-fluorouracil. Patients with an absolute neutrophil count of <1.5 × 109/L (range 0.1 × 109/L–1.4 × 109/L) received 170 cycles of FOLFOX. Chemotherapy administered to patients with grade 2 neutropenia predicted higher grades of neutropenia with a sensitivity of 0.22 (95% CI, 0.12 – 0.38). Treatment delay of 1 week occurred in 24 cycles due to hematologic reasons.

The researchers concluded that the administration of FOLFOX to patients with low day-before absolute neutrophil count was beneficial in terms of higher received dose intensity and fewer clinic visits.


1. Chiarotto JA, Dranitsaris G. FOLFOX chemotherapy can safely be given to neutropenic patients with early-stage colorectal cancer for higher dose intensity and fewer visits [published online ahead of print December 22, 2015]. Support Care Cancer. doi: 10.1007/s00520-015-3059-0.