Browsing by Author "Seid, Fahmi Usman"

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    Relative Dose Intensity and Myelotoxicity of FOLFOX4 Chemotherapy Among Colorectal Cancer Patients at Tikur Anbessa Hospital
    (Addis Ababa University, 2020-10) Seid, Fahmi Usman; Dr.Assefa, Mathewos(MD, Associate Professor of Clinical Oncology)
    Background: Colorectal cancer (CRC) is a major global health problem and public health issue. Despite the improved outcome with cytotoxic treatment of CRC, outcomes are affected by adverse treatment effects and their sequel, often resulting in low Relative dose intensity (RDI), considerable, mortality, morbidity and costs. However, there are no previous studies conducted in our clinical practice setting describing the Relative dose intensity of FOLFOX4 or its predicters. Objective: Our main objective of the study was to determine FOLFOX4 regimen RDI and its predicters, describe incidence of dose delay and dose limiting neutropenia. Methods: We conducted a retrospective medical record review on 82 CRC patients treated at Tikur Anbessa hospital between May 2019 and July 2020 with FOLFOX4. RDI was calculated with Excel 2019 and entered in to SPSS 26.0 for summary statistics. Reason for delay were assessed through all the 12 cycles. Dose delay were categorized as > 7 days, 7 to 18 days, and more than 18 days. To identify predicters, sensitivity analyses was performed by categorizing RDI based on 25 th and 75 th percentile and covariates were entered in to multinomial logistic regression model for multivariate analysis. Results: We identified 82 patients receiving FOLFOX chemotherapy as first line treatment. The mean age was 45 years, and 42.7% were female. The average RDI was 48.6 %. The proportion of patients receiving average RDI less than 85% is 92.7% (N=76). Among stage II and III subgroups, the patients receiving RDI > 70%, are 22.2% and 19% respectively. Myelo suppression in particular Grade II to IV neutropoenias were dose delaying reason in 61.3% of the cases, while non cytopenia related dose delays were observed in 31.7%(n=26) of the patients. Dose schedule modification resulting in treatment prolongation more than 18 days were affecting 38.3% (N=239) of the cycles. The odds of receiving RDI less than 35% increases by 66%, for each decrease in the cycle number for nadir neutropenia count compared to above 60%; AOR=0.44(CI: 0.22, 0.89) at statistically significant p-value=0.02. Conclusion: Overall FOLFOX chemotherapy RDI was low. Dose limiting myelotoxicity were the main reason for dose modification and were observed at higher rate affecting majority of cycles, and patients. Cycle number for nadir neutropenia independently predicted the risk of falling in to 25 th RDI percentile compared 75 th percentile, on the sensitivity analysis.