Supportive Care in Cancer

, Volume 20, Issue 10, pp 2523–2530

Primary G-CSF prophylaxis for adjuvant TC or FEC-D chemotherapy outside of clinical trial settings: a systematic review and meta-analysis

Original Article

DOI: 10.1007/s00520-011-1375-6

Cite this article as:
Younis, T., Rayson, D. & Thompson, K. Support Care Cancer (2012) 20: 2523. doi:10.1007/s00520-011-1375-6



Variable febrile neutropenia (FN) rates reported with adjuvant TC (taxotere®, cyclophosphamide) and FEC-D (5-flurouracil, epirubicin, cyclophosphamide, docetaxel) outside of clinical trials have precluded definitive recommendations for primary G-CSF (granulocyte colony-stimulating factor) prophylaxis in most jurisdictions. A systematic review and meta-analysis was conducted to assess: (a) FN rates associated with TC and FEC-D without primary G-CSF prophylaxis outside of clinical trial settings, and (b) the potential impact of G-CSF prophylaxis on FN prevention.


A MEDLINE search was conducted and major conference abstracts were reviewed up to June 15th 2011 to identify all relevant English-language studies. Random- and fixed-effects meta-analysis models were performed.


Nine hundred two patients treated with TC and 1342 with FEC-D from 13 to 9 studies, respectively, were included. The pooled random-effects meta-analysis estimates of FN rates for TC and FEC-D without G-CSF were 29% (95% CI 24–35%) and 31% (95% CI 27–35%), with a 76% (RR = 0.24, 95% CI 0.14–0.41) and 63% (RR = 0.37, 95% CI 0.11–1.24) relative risk reduction with G-CSF, respectively.


In routine clinical practice, TC and FEC-D without G-CSF are associated with FN rates exceeding the 20% threshold for which primary G-CSF prophylaxis is commonly recommended, and are considerably higher than those reported in pivotal clinical trials.


Febrile neutropenia Breast cancer Adjuvant chemotherapy G-CSF Prophylaxis Docetaxel Supportive care 

Supplementary material

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Tallal Younis
    • 1
    • 2
    • 3
  • Daniel Rayson
    • 1
    • 2
  • Kara Thompson
    • 2
  1. 1.Atlantic Clinical Cancer Research Unit (ACCRU)Dalhousie UniversityHalifaxCanada
  2. 2.Department of Medicine, Queen Elizabeth II Health Sciences CentreDalhousie UniversityHalifaxCanada
  3. 3.HalifaxCanada

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