Growth factor use and rate of neutropenic complications in breast cancer patients treated with dose-dense paclitaxel: A 5-year experience from a safety net hospital.

Abstract

6527 Background: The NCCN guidelines recommend growth factor (G-CSF) support to reduce the risk of febrile neutropenia and maintain dose density in patients receiving dose dense chemotherapy. We retrospectively reviewed growth factor utilization with dose dense paclitaxel (ddT) in breast cancer patients treated at our institution. Methods: Electronic medical records of patients treated at Parkland Health and Hospital System between 2012-2017 for breast cancer with dose dense adriamycin and cyclophosphamide (ddAC) followed by ddT were reviewed. Data on patient characteristics as well as G-CSF use and neutropenic complications were collected. Results: Two-hundred sixty eight patients received a total of 1019 cycles of ddT. Only one physician in the practice routinely prescribed G-CSF after ddT. The majority of ddT cycles were administered without G-CSF support (781 vs 238 cycles). There were no episodes of neutropenic fever in either group. The rate of grade 3/4 neutropenia was 2.1 % with G-CSF support (all grade 3), and 2.7% without G-CSF support (85% grade 3), p = 0.61. Treatment delays were longer in patients who did not receive G-CSF support, but this difference was not statistically significant (mean of 4 vs 2.2 days, p = 0.07). The number of cycles needed to treat to prevent 1 episode of grade 3/4 neutropenia was 167. Based on Medicare average sales price (ASP) for pegfilgrastim, routine use of G-CSF in our patient population would have added over $3.6M to the cost of care over the study period. Conclusions: Our results show a similarly low rate of neutropenic complications in patients receiving dose dense paclitaxel with or without G-CSF support. Therefore routine use of G-CSF with this regimen is not warranted. Judicious use of expensive medications such as G-CSF would reduce the cost of care and financial toxicity to patients, and promote high value care.