Febrile neutropenia in FEC-D regimen for early stage breast cancer: is there a place for G-CSF primary prophylaxis?

Abstract

Background: Breast cancer clinical trials prove better outcomes for anthracycline-taxane regimes albeit of a higher hematologic toxicity. Original trials may under-estimate febrile neutropenia (FN) event rates.

Objective: To describe the occurrence of FN events related to FEC-D for breast cancer treatment in the real-life setting.

Methods: Retrospective analysis of 189 patients with non-metastatic breast cancer consecutively treated with FEC-D (3 cycles of 5-FU, Epirubicin and Cyclophosphamide followed by 3 cycles of Docetaxel) at our Center during 33 months. FN and related dose delay and reduction, regimen change, G-CSF prophylaxis and hospitalization were analyzed.

Results: Fifty-one patients (27%) developed at least one episode of FN during FEC-D, 21% during Docetaxel cycles. There were 61 (5.6%) FN episodes in 1100 cycles of FEC-D administered, 77% occurred during Docetaxel cycles (46% on the first D cycle). G-CSF was used in 5.8% of cycles. Hospital admission needed in 54.1% of FN events, 16.4% prompted dose reduction and 23% next cycle delay. There were no FN related deaths.

Conclusions: G-CSF prophylaxis is recommended for chemotherapy regimens associated with a FN rate higher than 20%. Based on our FN rates, we now recommend primary G-CSF prophylaxis during the administration of cycles 4 to 6 in FEC-D.

Keywords: Febrile neutropenia; breast cancer; docetaxel; granulocyte colony-stimulating factor.