487P Real-world feasibility of adjuvant TAC with pegylated G-CSF in resectable breast cancer: A single-center experience

Abstract

Background Although adjuvant TAC is a viable treatment option for operable breast cancer, concern for non-negligible toxicity, particularly of febrile neutropenia, has been consistent. In this study, we aimed to figure out virtual toxicity profiles in patients who received adjuvant TAC with concurrent use of pegylated G-CSF. Methods We retrospectively reviewed the medical charts of 127 patients with operable breast cancer who received adjuvant TAC with pegylated G-CSF between July of 2014 and April of 2016 in Asan Medical Center (Seoul). All patients were supported by pegylated G-CSF from the first cycle of chemotherapy.Tabled 1Table: 487P Toxicity profilesToxicityTotal (n=145)AnyGradeGrade 3,Grade 4,grade,1/2,N (%)N (%)N (%)N (%)HematologicNeutropenia14 (11.0)1 (0.8)4 (3.1)9 (7.1)Febrile neutropenia7 (5.5)-7 (5.5)-Cycle 14 (57.1)Cycle 21 (14.3)Cycle 52 (28.6)Infection without4 (3.1)3 (2.4)1 (0.8)neutropeniaAnemia15 (11.8)14 (11)-1 (0.8)Thrombocytopenia1 (0.8)--1 (0.8)Non-HematologicStomatitis35 (27.6)35 (27.6)-Skin rash13 (10.2)12 (9.5)1 (0.8)Asthenia7 (5.5)7 (5.5)-Generalized edema29 (22.8)29 (22.8)-Myalgia57 (44.9)56 (44.1)1 (0.8)Headache or dizziness13 (10.2)13 (10.2)-Peripheral neuropathy43 (33.9)43 (33.9)-Fever6 (4.7)6 (4.7)-AST/ALT elevation3 (2.4)3 (2.4)Weight loss8 (6.3)8 (6.3)-Drug-induced--1 (0.8)pneumonitisCongestive heart failure---Alopecia28 (22.0)5 (4.0)1(0.8)Anorexia19 (15.0)19 (15.0)-Nausea63 (49.6)63 (49.6)-Vomitting11 (8.7)11 (8.7)-Abdominal discomfort*23 (18.1)23 (18.1)-Diarrhea21 (16.5)18 (14.2)3 (2.4)Constipation16 (12.6)16 (12.6)- Open table in a new tab Results During the median follow-up period of 8.8 months (range, 8.1-9.4), a total of 746 cycles of adjuvant TAC were administerd to 127 patients, and 5 patients eventually discontinued the treatment because of significant adverse events (n=2,1.6%) or refusal (n=3,2.4%). Febrile neutropenia was reported in 7 patients (5.5%), which were mostly confined to cycle 1 or 2 (71.4%). Median duration of hospital stay and time for recovery of neutropenia were 2 days. Toxicities were generally grade 1 or 2, of which nausea and myalgia were most frequent (Table). However, among 122 patients completed 6 cycles of adjuvant TAC, dose reduction or delay was found in 36 cases in 33 patients (27.0%); 13 cases:hematologic toxicities, 23 cases:non-hematologic toxicities. Febrile neutropenia (n=6, 4.8%) and peripheral neuropathy (n=6, 4.8%) were two most causative toxicities. Relative dose intensities of docetaxel, doxorubicin, and cyclophosphamide were 96%, 97%, and 98%, respectively. There has been no documented relapse or death. Conclusions Concurrent use of pegylated G-CSF could significantly reduce the incidence of febrile neutropenia and its fatality. However, a considerable number of dose reduction or delay from non-hematologic toxicities warrants careful selection of patient receiving adjuvant TAC, and further improvement of docetaxel-based regimen is needed. Legal entity responsible for the study N/A Funding N/A Disclosure All authors have declared no conflicts of interest.