Abstract
For high-risk breast cancer patients with positive axillary lymph nodes, dose-dense every-two-week epirubicin/cyclophosphamide-paclitaxel (ddEC-P) regimen is the optimal postoperative adjuvant therapy. However, this regimen is limited by the grade 3/4 neutropenia and febrile neutropenia (FN). There is an urgent need to explore the efficacy, safety and proper dosage of PEGylated granulocyte colony-stimulating factor (PEG-G-CSF) as support for ddEC-P in Chinese breast cancer patients with positive axillary lymph nodes. Prospectively, 40 women with stage IIIA to IIIC breast cancer received ddEC-P ± trastuzumab as adjuvant treatment. PEG-G-CSF was injected subcutaneously in a dose of 6 mg or 3 mg on the 2th day of each treatment cycle. With administration of PEG-G-CSF, all of the 40 patients completed 8 cycles of ddEC-P ± trastuzumab regimen without dose reductions or treatment delays. Moreover, no FN cases were observed. Further analysis showed that the proper dosage of PEG-G-CSF was 6 mg for ddEC treatment, and 3 mg for ddP treatment. PEG-G-CSF exhibits advantages compared with G-CSF in convenient of administration and tolerance for high risk Chinese breast cancer patients. More importantly, the proper dose of PEG-G-CSF for high risk Chinese breast cancer patients during ddEC-P chemotherapy may be 6 mg for ddEC treatment and 3 mg for ddP treatment.
Highlights
Adjuvant chemotherapy is an effective therapeutic strategy for patients with node positive breast cancer
Several studies have demonstrated that compared with a conventional three-week schedule, the dose-dense epirubicin plus cyclophosphamide followed by paclitaxel regimen can significantly improve disease-free survival www.impactjournals.com/oncotarget (DFS) and overall survival (OS) of the patients with high-risk breast cancer
The use of Polyethylene glycol (PEG)-G-CSF allows for adequate neutrophil recovery in postoperative Chinese female patients with node positive breast cancer, receiving adjuvant dose-dense epirubicin plus cyclophosphamide followed by paclitaxel (ddEC-P) chemotherapy
Summary
Adjuvant chemotherapy is an effective therapeutic strategy for patients with node positive breast cancer. Several studies have demonstrated that compared with a conventional three-week schedule, the dose-dense epirubicin plus cyclophosphamide followed by paclitaxel (ddEC-P) regimen can significantly improve disease-free survival www.impactjournals.com/oncotarget (DFS) and overall survival (OS) of the patients with high-risk breast cancer. Dose-dense adjuvant chemotherapy has been widely used for high risk breast cancer patients [1, 2]. The dose-dense regimen requires growth factor support for hematologic recovery between cycles [3, 4]. It is imperative to prevent myelosuppression and grade 3/4 neutropenia during postoperative dose-dense adjuvant therapy for high-risk breast cancer patients [5, 6]. The short half-life of G-CSF requires daily dosing which limits its wide application in ddEC-P treatment
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