Nonneutropenic febrile episodes associated with docetaxel-based chemotherapy in patients with solid tumors

Cancer. 2002 Sep 15;95(6):1326-33. doi: 10.1002/cncr.10802.


Background: Docetaxel is associated with severe lymphopenia and increased incidence of nonneutropenic infection. This study investigated the incidence of nonneutropenic infections and/or febrile episodes in patients with solid tumors receiving frontline docetaxel-based chemotherapy.

Methods: Chemotherapy-naive patients with solid tumors treated with docetaxel-based chemotherapy were studied prospectively for the development of nonneutropenic infections.

Results: During a 2-year period, 680 cancer patients enrolled in 24 protocols received 2867 cycles of docetaxel-containing chemotherapy. Fifty-three patients (7.8%) developed nonneutropenic infections and/or febrile episodes. The most common of these were pulmonary infections (n = 25), Pneumocystis carinii interstitial pneumonias (n = 5), and candidal (n =11), herpetic (n =4), and cytomegaloviral (n =3) infections. Thirty-six patients (68%) had severe lymphopenia (< 900 cells per deciliter) and 49 (92%) had less than 400 CD4(+) cells per deciliter. Patients with a low CD4(+) cell count (</= 200 cells per deciliter) had a significantly higher probability to develop opportunistic than common infections (P = 0.002). The incidence of nonneutropenic infections and/or febrile episodes was significantly higher in patients treated with docetaxel/gemcitabine (18.3%; P = 0.0001) and docetaxel/CDDP (11.7%; P = 0.012) than in those treated with docetaxel alone (3.6%). Conversely, 175 patients who received 752 cycles of chemotherapy with paclitaxel-containing regimens and 410 patients who received 2174 cycles with nontaxane-based regimens developed 6 (3.4%; p=0.042) and 12 (3%; p=0.001) nonneutropenic infections, respectively. Less than 10% of the patients of the two latter groups were lymphopenic. The risk of nonneutropenic infection in patients receiving docetaxel-based chemotherapy was 2.38 and 2.8 times higher than in patients receiving paclitaxel and nontaxane-based chemotherapy, respectively.

Conclusions: Patients treated with docetaxel-based chemotherapy are at increased risk of developing nonneutropenic infections. This may be related, at least partly, to severe postchemotherapy CD4(+) lymphopenia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents, Phytogenic / administration & dosage
  • Antineoplastic Agents, Phytogenic / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols
  • Candidiasis / etiology
  • Cytomegalovirus Infections / etiology
  • Docetaxel
  • Fever / chemically induced*
  • Herpesviridae Infections / etiology
  • Humans
  • Infections / etiology*
  • Lung Diseases / etiology
  • Lymphopenia / chemically induced
  • Neoplasms
  • Paclitaxel / administration & dosage
  • Paclitaxel / adverse effects*
  • Paclitaxel / analogs & derivatives*
  • Pneumonia, Pneumocystis / etiology
  • Prospective Studies
  • T-Lymphocytopenia, Idiopathic CD4-Positive / chemically induced
  • Taxoids*


  • Antineoplastic Agents, Phytogenic
  • Taxoids
  • Docetaxel
  • Paclitaxel