A multicenter audit of the incidence of febrile neutropenia and neutropenia associated with docetaxel and cyclophosphamide (TC) chemotherapy for early breast cancer.

Abstract

1079 Background: A 2006 US Oncology trial reported that four cycles of docetaxel and cyclophosphamide (TC) resulted in better disease free and overall survival than four cycles of doxorubicin and cyclophosphamide (AC) in women with early breast cancer (EBC) and TC is now a frequently used adjuvant chemotherapy regimen for EBC. The 2006 trial reported that TC was associated with a 5% incidence of febrile neutropenia (FN), but others have noted a higher incidence of FN. Methods: We have conducted a multicentre retrospective audit of women with EBC treated with TC between January 2010 and July 2011, recruited from seven Australian centres. The primary endpoints of the study were the incidence of FN associated with the use of TC and also the incidence of grade 3 or 4 neutropenia during cycle one of TC. Patients receiving prophylactic granulocyte colony stimulating factor (G–CSF) or prophylactic antibiotics were excluded. Results: Of a total of 368 previously untreated women with EBC who received TC, 300 were evaluable for FN. The median age of the patients was 57 years. Overall, 73 (24.3%) patients developed FN. The highest incidence of FN was seen after cycle one (91.8%) of TC and the incidence of FN appeared higher in women under the age of 65 years. Of 304 patients evaluable for neutropenia during cycle one, eight (2.6%) developed grade 3 neutropenia and 191 (62.8%) developed grade 4 neutropenia. Conclusions: This is the largest study to date which reveals that TC is associated with a high incidence of grade 4 neutropenia and a high incidence of FN. The incidence of FN is above the 20% threshold for the use of G-CSF as primary prophylaxis as recommended by The EORTC and The National Comprehensive Cancer Network. Therefore, we recommend that G-CSF be considered as primary prophylaxis when TC is used as adjuvant chemotherapy for EBC.