The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin's lymphoma

Abstract

BackgroundThe use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The existence of a medical need for G-CSF primary and secondary prophylaxis with these regimens was investigated in a real-life setting.MethodsNine oncologists and six hematologists from different Belgian general hospitals and university centers were surveyed to collect expert opinion and real-life data (year 2007) on the use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the clinical management of FN in patients aged <65 years with breast cancer or NHL. Data were retrospectively obtained, over a 6-month observation period.ResultsThe most frequently used regimens in breast cancer patients (n = 161) were FEC (45%), FEC-T (37%) and docetaxel alone (6%). In NHL patients (n = 39), R-CHOP-21 (33%) and R-ACVBP-14 (15%) were mainly used. Without G-CSF primary prophylaxis (PP), FN occurred in 31% of breast cancer patients, and 13% had PSN. After G-CSF secondary prophylaxis (SP), 4% experienced further FN events. Only 1 breast cancer patient received PP, and did not experience a severe neutropenic event. Overall, 30% of chemotherapy cycles observed in breast cancer patients were protected by PP/SP. In 10 NHL patients receiving PP, 2 (20%) developed FN, whereas 13 (45%) of the 29 patients without PP developed FN and 3 (10%) PSN. Overall, 55% of chemotherapy cycles observed in NHL patients were protected by PP/SP. Impaired chemotherapy delivery (timing and/or dose) was reported in 40% (breast cancer) and 38% (NHL) of patients developing FN. Based on oncologist expert opinion, hospitalization rates for FN (average length of stay) without and with PP were, respectively, 48% (4.2 days) and 19% (1.5 days). Similar rates were obtained from hematologists.ConclusionsDespite the studied chemotherapy regimens being known to be associated with a moderate or high risk of FN, upfront G-CSF prophylaxis was rarely used. The observed incidence of severe neutropenic events without G-CSF prophylaxis was higher than generally reported in the literature. The impact on medical resources used is sizeable.

Real-World Impact of Granulocyte-Colony Stimulating Factor on Febrile Neutropenia

“…Interestingly, the reported incidence of fn associated with specific chemotherapy regimens is higher in clinical practice than in clinical trials 19,21,[23][24][25] . Likewise, although international guidelines are clear on the use of g-csf prophylaxis, data on such use in clinical practice remain scarce.…”

“…Although the risk of fn for several chemotherapy regimens has been widely described within the context of clinical trials, only a few studies have described the occurrence of fn in clinical practice [19][20][21][22][23] . Interestingly, the reported incidence of fn associated with specific chemotherapy regimens is higher in clinical practice than in clinical trials 19,21,[23][24][25] .…”

“…Existing literature shows that the incidence of fn observed in clinical trials is different from that seen (5-fluorouracil-epirubicin-cyclophosphamide followed by docetaxel), n = 211; ac-t (doxorubicin-cyclophosphamide-paclitaxel), n = 1. e tc (docetaxel-cyclophosphamide), n = 26; tch (docetaxel-platinum and trastuzumab), n = 1. g-csf = granulocyte colony-stimulating factor; er = estrogen receptor; pr = progesterone receptor; her2 = human epidermal growth factor receptor 2. in clinical practice [22][23][24][25]27 . Consistent with such reports, we show that the incidence of fn in "real life" is higher than that reported in clinical trials.…”

The Use of Granulocyte Colony–Stimulating Factors in a Canadian Outpatient Setting

“…Interestingly, a study by Gerlier et al 26 reported a fn event for 31% of breast cancer patients who did not receive g-csf primary prophylaxis, and another recent study (Rajan et al 27 ) reported that primary prophylaxis with a g-csf led to a 16% reduction in hospitalizations within the first 3 months of chemotherapy initiation.…”

Priorities and challenges for skin cancer prevention in Europe

“…Expert surveys are useful as alternative methods to obtain information when objective clinical and epidemiological data are incomplete [19,41,42]. Expert surveys are useful as alternative methods to obtain information when objective clinical and epidemiological data are incomplete [19,41,42].…”