High incidence of febrile neutropenia following adjuvant breast chemotherapy with docetaxel, carboplatin and trastuzumab

Abstract

SUMMARY Aim: To determine the incidence of febrile neutropenia (FN) following adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH) for early-stage breast cancer and the grade of neutropenia after cycle one. Methods: A retrospective multicenter audit of patients with early-stage breast cancer treated with TCH, was conducted at four Australian hospitals between October 2009 and September 2013. Results: Of 79 patients analyzed, data from 78 women were evaluated for FN incidence and data from 64 women were evaluated for grade of neutropenia. After cycle one of TCH, 26 patients developed FN (33.3%). Following all cycles, 32 patients developed FN (41.0%). There was no statistical difference in the incidence of FN between hospitals or between age groups (above or below 65 years). After cycle one, ten patients developed grade 3 neutropenia (15.6%) and 37 patients developed grade 4 neutropenia (57.8%). Conclusion: This study demonstrates a high incidence of FN post-TCH chemotherapy thus supporting the use of granulocyte colony-stimulating factor as primary prophylaxis.

Evaluation of the Use of Granulocyte Colony-Stimulating Factors (G-CSFs) for Neutropenia Primary Prophylaxis in Solid Tumors at a Tertiary Care Hospital, Retrospective Study

“…Another study found that G-CSFs was being over utilized in patients undergoing chemotherapy associated with low risk of FN and underutilized in patients with high risk of FN. This finding is similar to ours, whereby G-CSFs were underutilized in patients with high risk of FN [17][18][19][20][21][22][23][24][25]. However, G-CSFs were prescribed appropriately in intermediate-and low-risk patients at our institution.…”

Risk of Febrile Neutropenia Associated With Select Myelosuppressive Chemotherapy Regimens in a Large Community-Based Oncology Practice

“…Both regimens are now classified as high-risk FN regimens in the current guidelines. [13][14][15] FOLFOX has been classified as an intermediate-risk regimen based on clinical trial findings for FOLFOX4. 7,16 FN risk for FOLFOX6, an alternative regimen with a more simplified administration of 5-fluorouracil infusion, 17 remains unclassified.…”

Treatment of HER2-positive early breast cancer: How to best balance efficacy and toxicity?

“…For instance, the US Oncology group reported a 5% FN incidence in patients receiving TC (docetaxel/cyclophosphamide) regimen, while numerous studies using the same regimen have reported a much higher incidence of FN ranging between 25% and 50%, being 29% in a pooled meta‐analysis . Likewise, the incidence of FN among patients treated with TCH has been reported to range from 7.1% to 41.0%, being 9.8% in the BCIRG‐006 trial . Importantly, in this trial, another 11% of TCH‐treated patients developed neutropenic infection, which collectively brings neutropenia‐associated complications to the 20% threshold, proposed for PPG.…”