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Supportive Care in Cancer
Published in: Supportive Care in Cancer 4/2011

01-04-2011 | Original Article

Impact of colony-stimulating factors to reduce febrile neutropenic events in breast cancer patients receiving docetaxel plus cyclophosphamide chemotherapy

Authors: Alexandre Chan, Wing Hang Fu, Vivianne Shih, Jurja Chua Coyuco, Sze Huey Tan, Raymond Ng

Published in: Supportive Care in Cancer | Issue 4/2011

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Abstract

Background

Data from US Oncology Adjuvant Trial 9735 has shown that four cycles of docetaxel plus cyclophosphamide (TC) improved disease-free and overall survival when compared against doxorubicin and cyclophosphamide (AC) in early-stage breast cancer. The febrile neutropenia (FN) rate was 4% in this study without primary granulocyte colony-stimulating factors (G-CSF) prophylaxis. However, the incidence of docetaxel-induced myelosuppression is recognized to be higher among Asian population. Hence, this study was designed to evaluate the impact of G-CSF to reduce FN-related events in Asian cancer patients treated with TC.

Method

This retrospective cohort study was conducted on Asian breast cancer patients who have received intravenous docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2 between 2006 to 2008. Patients did not receive oral antibiotic prophylaxis, and prophylactic G-CSF after chemotherapy was prescribed under the discretion of the primary oncologist.

Results

During cycle 1 of chemotherapy, 6.3% patients received G-CSF manifested FN, while 25% patients who did not receive G-CSF manifested FN (RR = 0.252, 95% CI 0.102 to 0.622). Introduction of G-CSF as primary prophylaxis provided an absolute risk reduction of FN events by 18.7%. Chemotherapy doses were maintained throughout all cycles. Patients with pretreatment white blood cell counts (WBC) below 6.0 × 103/mm3 and absolute neutrophil counts (ANC) below 3.1 × 103/mm3 were associated with higher rates of FN during Cycle 1 (p = 0.009, p = 0.007).

Conclusions

Our findings indicate that TC was associated with higher rates of FN than reported in the clinical trial. The 25% incidence fulfills the requirement of primary prophylaxis with G-CSF. Routine administration of G-CSF is highly recommended to reduce the rates of FN in breast cancer patients receiving TC.
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Metadata
Title
Impact of colony-stimulating factors to reduce febrile neutropenic events in breast cancer patients receiving docetaxel plus cyclophosphamide chemotherapy
Authors
Alexandre Chan
Wing Hang Fu
Vivianne Shih
Jurja Chua Coyuco
Sze Huey Tan
Raymond Ng
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 4/2011
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-010-0843-8

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