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Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors

  • Epidemiology
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Abstract

Opportunistic infection with Pneumocystis jiroveci pneumonia (PCP) has not been recognized as a significant complication of early-stage breast cancer treatment. However, we have observed an increase in PCP incidence among patients receiving chemotherapy for early-stage breast cancer. Herein we identify risk factors for and calculate incidence of PCP in this population. We identified all cases of PCP at Dana–Farber Cancer Institute/Brigham and Women’s Hospital (DFCI/BWH) from 1/1/2000 to 12/31/2013 in patients with stage I–III breast cancer treated with an adriamycin/cyclophosphamide (AC)-containing regimen. Nineteen cases of PCP in non-metastatic breast cancer patients were identified. All patients with PCP were diagnosed after receipt of either three or four cycles of AC chemotherapy on a dose-dense schedule. Patients who developed PCP were treated with median 16.4 mg prednisone equivalents/day as nausea prophylaxis for a median 64 days. The overall incidence of PCP among 2057 patients treated with neoadjuvant or adjuvant dose-dense AC for three or more cycles was 0.6 % (95 % confidence interval 0.3–1.0 %). No PCP was diagnosed in 1001 patients treated with non-dose-dense AC. There was one death from PCP. Women receiving dose-dense AC chemotherapy for early-stage breast cancer are at risk for PCP. Administering the same chemotherapy and corticosteroid dose over an 8-week versus 12-week non-dose-dense schedule appears to have created a novel infectious vulnerability. Replacing dexamethasone with alternative anti-emetics may mitigate this risk.

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Acknowledgments

The authors wish to thank Alexandra Nano BS (Brigham and Women’s Hospital) for help with preparation of Fig. 1. This work was supported by institutional funding.

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    Authors and Affiliations

    1. Dana-Farber Cancer Institute, Boston, MA, USA

      Adrienne G. Waks, Sara M. Tolaney, Amal Arnaout, Francisco M. Marty, Eric P. Winer, Sarah P. Hammond & Lindsey R. Baden

    2. Brigham and Women’s Hospital, Boston, MA, USA

      Adrienne G. Waks, Sara M. Tolaney, Alicia Galar, Francisco M. Marty, Eric P. Winer, Sarah P. Hammond & Lindsey R. Baden

    3. Harvard Medical School, Boston, MA, USA

      Adrienne G. Waks, Sara M. Tolaney, Francisco M. Marty, Eric P. Winer, Sarah P. Hammond & Lindsey R. Baden

    4. Stanford Health Care, Stanford, CA, USA

      Julie B. Porter

    5. Brigham and Women’s Hospital, 75 Francis Street, PBB-A4, Boston, MA, 02115, USA

      Lindsey R. Baden

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    1. Adrienne G. Waks
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    Correspondence to Lindsey R. Baden.

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    Conflict of Interest

    The authors disclose the following financial relationships, which may be directly or indirectly related to the current work: Sara M. Tolaney (Genentech); Eric P. Winer (Verastem, Genentech).

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    All of the work included herein complied with the current laws of the U.S.A., where research was performed.

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    Adrienne G. Waks, Sara M. Tolaney, and Alicia Galar contributed equally to this article.

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    Waks, A.G., Tolaney, S.M., Galar, A. et al. Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors. Breast Cancer Res Treat 154, 359–367 (2015). https://doi.org/10.1007/s10549-015-3573-2

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    • DOI: https://doi.org/10.1007/s10549-015-3573-2

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