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

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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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Acknowledgments

Authors would like to acknowledge the Department of Pharmacy, National University of Singapore for providing Final Year Project funding for this project.

Conflict of interest

The authors have no conflicts of interest that are directly relevant to the content of this study.

Authors’ contributions

AC, VS and RN are involved with the planning of the project, writing the manuscript, performing data analysis and interpretation of data. FWH and CJC are involved with the data collection and data analysis of the study. TSH has performed the statistical analysis of the study. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, Singapore, 117543

    Alexandre Chan, Wing Hang Fu & Jurja Chua Coyuco

  2. Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore

    Alexandre Chan & Vivianne Shih

  3. Division of Clinical Trials & Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore

    Sze Huey Tan

  4. Centre of Quantitative Biology and Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore

    Sze Huey Tan

  5. Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore

    Raymond Ng

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  1. Alexandre Chan
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  2. Wing Hang Fu
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  3. Vivianne Shih
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Correspondence to Alexandre Chan.

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Chan, A., Fu, W.H., Shih, V. et al. Impact of colony-stimulating factors to reduce febrile neutropenic events in breast cancer patients receiving docetaxel plus cyclophosphamide chemotherapy. Support Care Cancer 19, 497–504 (2011). https://doi.org/10.1007/s00520-010-0843-8

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  • DOI: https://doi.org/10.1007/s00520-010-0843-8

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