CC BY-NC-ND 4.0 · South Asian J Cancer 2020; 09(01): 04-06
DOI: 10.4103/sajc.sajc_439_18
ORIGINAL ARTICLE: Breast Cancers

Incidence of febrile neutropenia with commonly used chemotherapy regimen in localized breast cancer

Nageswara Reddy Palukuri
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
,
Rajani Priya Yedla
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
,
Stalin Chowdary Bala
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
,
Siva Prasad Kuruva
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
,
Rachana Chennamaneni
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
,
Meher Lakshmi Konatam
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
,
Sadashivudu Gundeti
Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
› Author Affiliations
Financial support and sponsorship: Nill.

Abstract

Introduction: Breast cancer is the most frequently diagnosed cancer among the women. Most commonly used chemotherapy regimen is Doxorubicin and Cyclophosphamide (AC) which carries significant risk of febrile neutropenia. The aim of the study is to identify the incidence of febrile neutropenia and its effects on the delivery of chemotherapy in patients receiving following AC chemoregimen without primary prophylaxis. Materials and Methods: We retrospectively analyzed the case records of the localized breast cancer patients who were treated with AC chemoregimen without primary prophylaxis for febrile neutropenia. Results: Between 2013 and 2017, a total of 231 cases received AC chemoregimen. A total of 14 (6.1%) patients were found to have febrile neutropenia. All patients were recovered by day 19 and no deaths were observed. Except for ECOG performance status (P = 0.001) no significant association was found with age, co-morbidities, menopausal status, body surface area and stage of the cancer. There were no treatment delays or dose reductions because of febrile neutropenia. Conclusion: The incidence of FN with AC chemotherapy in breast cancer patients is relatively less in the present study. Routine primary prophylaxis is not recommended as this chemotherapy falls in to low risk category for FN but can be considered for patients with ECOG PS > 1. If the diagnosis of febrile neutropenia and institution of appropriate measures are prompt, FN did not affect the delivery of chemotherapy and thus compromise survival.



Publication History

Article published online:
14 December 2020

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  • 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
  • 2 Bonadonna G, Valagussa P. Dose-response effect of adjuvant chemotherapy in breast cancer. N Engl J Med 1981;304:10-5.
  • 3 Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006;106:2258-66.
  • 4 Tai E, Guy GP, Dunbar A, Richardson LC. Cost of cancer-related neutropenia or fever hospitalizations, United States, 2012. J Oncol Pract 2017;13:e552-61.
  • 5 Barnes G, Pathak A, Schwartzberg L. G-CSF utilization rate and prescribing patterns in United States: Associations between physician and patient factors and GCSF use. Cancer Med 2014;3:1477-84.
  • 6 Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol 2016;27:v111-v118.
  • 7 Chan A, Chen C, Chiang J, Tan SH, Ng R. Incidence of febrile neutropenia among early-stage breast cancer patients receiving anthracycline-based chemotherapy. Support Care Cancer 2012;20:1525-32.
  • 8 von Minckwitz G, Raab G, Caputo A, Schütte M, Hilfrich J, Blohmer JU, et al. Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: The GEPARDUO study of the German breast group. J Clin Oncol 2005;23:2676-85.
  • 9 Citron ML, Berry DA, Cirrincione C, Hudis C, Winer EP, Gradishar WJ, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer:First report of intergroup trial C9741/Cancer and leukemia group B trial 9741. J Clin Oncol 2003;21:1431-9.
  • 10 Fumoleau P, Chauvin F, Namer M, Bugat R, Tubiana-Hulin M, Guastalla JP. Intensification of adjuvant chemotherapy: 5-year results of a randomized trial comparing conventional doxorubicin and cyclophosphamide with high-dose mitoxantrone and cyclophosphamide with filgrastim in operable breast cancer with 10 or more involved axillary nodes. J Clin Oncol 2001;19:612-20.
  • 11 Leonard RC, Miles D, Thomas R, Nussey F, UK Breast Cancer Neutropenia Audit Group. Impact of neutropenia on delivering planned adjuvant chemotherapy: UK audit of primary breast cancer patients. Br J Cancer 2003;89:2062-8.
  • 12 Kim CG, Sohn J, Chon H, Kim JH, Heo SJ, Cho H. Incidence of febrile neutropenia in Korean female breast cancer patients receiving preoperative or postoperative doxorubicin/Cyclophosphamide followed by docetaxel chemotherapy. J Breast Cancer 2016;19:76-82.
  • 13 Kim HS, Lee SY, Kim JW, Choi YJ, Park IH, Lee KS. Incidence and predictors of febrile neutropenia among early-stage breast cancer patients receiving anthracycline-based chemotherapy in Korea. Oncology 2016;91:274-82.
  • 14 O'Donnell PH, Dolan ME. Cancer pharmacoethnicity: Ethnic differences in susceptibility to the effects of chemotherapy. Clin Cancer Res 2009;15:4806-14.
  • 15 Aminkeng F, Ross CJ, Rassekh SR, Hwang S, Rieder MJ, Bhavsar AP. Recommendations for genetic testing to reduce the incidence of anthracycline-induced cardiotoxicity. Br J Clin Pharmacol 2016;82:683-95.
  • 16 Lyman GH, Abella E, Pettengell R. Risk factors for febrile neutropenia among patients with cancer receiving chemotherapy: A systematic review. Crit Rev Oncol Hematol 2014;90:190-9.