CHEMOPROPHYLAXIS WITH ORAL CIPROFLOXACIN IN OVARIAN-CANCER PATIENTS RECEIVING TAXOL

The purpose of this study was to review the clinical outcomes and cost of administration of a prophylactic antibiotic compared to G-CSF for the prevention of neutropenic morbidity associated with taxol. The stu dy group was composed of 62 patients with ovarian cancer who received a 24-h infusion of a taxol-based regimen at doses less than or equal t o 175 mg/m(2) between June 1992 and April 1994. The records were retro spectively reviewed and the patients were grouped and analyzed accordi ng to the management of their myelosuppression. Group I patients (n = 29) were observed until their absolute neutrophil count (ANC) was less than 500/mu l and then were placed on ciprofloxacin 500 mg orally twi ce a day until their ANC was 1000/mu l. Group II patients (n = 15) rec eived G-CSF from Day 2 until the ANC was greater than 10,000/mu l begi nning with their first cycle. Group III patients (n = 18) received the ir taxol regimen without either ciprofloxacin or G-CSF. Two hundred ei ghty-two taxol-based chemotherapy cycles were administered to these 62 patients. There was no statistically significant difference between t he groups concerning disease status as measured by age, stage, perform ance status, dose intensity, or number of previous regimens. There wer e two episodes of febrile neutropenia in Group I and three episodes in Group II, Group III had 15 episodes of febrile neutropenia. The estim ated cost of the different prophylactic regimens was $5215.00 for Grou p I versus $104,000.00 for G-CSF in Group II. Within the three groups, there were 27 patients with an episode of febrile neutropenia (n = 20 ) or prolonged myelosuppression (n = 7) that were followed for an addi tional 104 taxol cycles. Twenty-four of these patients received G-CSF prophylaxis with intermittent ciprofloxacin and three received only ci profloxacin. There were eight more episodes of febrile neutropenia in the patients receiving G-CSF. There were no additional febrile episode s on cycles prophylaxed with ciprofloxacin. There was no septic mortal ity. For patients receiving a 24 h infusion of taxol at doses less tha n 175 mg/m(2), ciprofloxacin given through the ANC nadir may be effect ive in preventing febrile morbidity. A prospective randomized trial is underway to evaluate this approach. (C) 1994 Academic Press, Inc.