Abstract
Purpose
The purpose of this study is to determine the incidence of febrile neutropenia (FN) among women receiving FEC-D (flurouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 500 mg/m2 every 3 weeks for three cycles followed by docetaxel 100 mg/m2 every 3 weeks for three cycles) chemotherapy for early stage breast cancer (ESBC) and the impact of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis in a non-clinical trial setting.
Patients and methods
A retrospective chart review of women referred for ESBC to The Moncton Hospital between 2005 and 2010 evaluated patient and disease characteristics, adjuvant chemotherapy receipt, G-CSF usage, FN incidence, hospital admission rates, and length of stay. Association of variables with FN was examined, and exploratory multivariable logistic regression modeling examined the impact of baseline variables on risk of FN.
Results
Of 520 patients enrolled in the database, 251 (48.3 %) received adjuvant chemotherapy for ESBC. Most (66.9 %) received FEC-D. Overall, 55 (21.9 %) patients developed FN. Forty-four (26.2 %) patients on FEC-D developed FN. Forty of 129 (31.0 %) FEC-D patients who did not receive primary G-CSF prophylaxis developed FN, versus 4 of 39 (10.3 %) receiving G-CSF. Receipt of FEC-D or TC (docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2 every 3 weeks for four or six cycles) was associated with odds ratios of 6.5 or 6.77, respectively, for the development of FN. Receipt of trastuzumab with chemotherapy was associated with an odds ratio of 3.48 for developing FN versus no trastuzumab. Primary G-CSF prophylaxis led to a 63 % reduction in the odds ratio of developing FN.
Conclusions
Incidence of FN with FEC-D treatment is considerably higher in clinical practice than reported in phase III trials. Consistent with ASCO guidelines, prophylactic G-CSF should be considered for all ESBC patients receiving adjuvant FEC-D.
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Acknowledgments
The authors gratefully acknowledge Tracey Allen, RN, for her assistance in patient identification and Dominique Richard for the expert administrative assistance. The authors also thank Dagmar Gross for the assistance with preparation of this manuscript.
Conflict of interest
Dr. H. Assi is a consultant for Amgen Canada Inc. and received research funding from Amgen Canada Inc. The remaining authors have no conflicts of interest to declare. As a courtesy, the manuscript was sent to Amgen Canada Inc. for review prior to submission, but no modifications were made based on their review. The opinions and analysis presented here are solely those of the authors. The authors have full control of all primary data and agree to allow the journal to review the data, if requested.
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This study was conducted at The Moncton Hospital, Moncton, New Brunswick, Canada.
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Assi, H., Murray, J., Boyle, L. et al. Incidence of febrile neutropenia in early stage breast cancer patients receiving adjuvant FEC-D treatment. Support Care Cancer 22, 3227–3234 (2014). https://doi.org/10.1007/s00520-014-2318-9
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DOI: https://doi.org/10.1007/s00520-014-2318-9