Hematologic toxicity with adjuvant docetaxel and cyclophosphamide in early breast cancer.

Abstract

Listen

Translate article

e11081 Background: After the results of docetaxel and cyclophosphamide (TC) superiority over doxorubicin and cyclophosphamide (AC) scheme, TC has been adopted at the A. C. Camargo Cancer Hospital as an option for adjuvant chemotherapy to early-breast cancer patients. However we have noticed a high rate of febrile neutropenia with this schedule. Methods: We conducted a retropective analysis of all patients with early breast cancer submitted to adjuvant chemotherapy with docetaxel 75 mg/m2 plus cyclophosphide 600 mg/m2, between January 2008 and July 2009, at A. C. Camargo Hospital in São Paulo-SP, Brazil. Primary end-point was to evaluate the rate of febrile neutropenia. Results: We have treated 30 women with TC. Median age was 55.7 years (33 to 76 years old). With regards to histologic caracteristics 58.6% were T1, 37.9% were T2, with a median tumor size of 16 mm; 6.9% had macroscopic positive axilar node; 65.5% patients were hormone receptor positive, 13.8% were HER2/neu positive. There was a total of 118 cycles of TC and we had 41.9% (n = 12) of patients with grade 3 or 4 neutropenia, and 31% (n = 9) needed hospitalization for febrile neutropenia (FN). Two patients initated TC with primary prophylaxis with growth factor. When we analysed only the first cycle, we found that 20.9% (n = 6) of patients had FN. After the first event, the use of secundary prophylaxis was initiated in all patients (n = 7) and there was still two further hospitalization for NF. One of them had dose reduction. Mean time of filgrastim 300 mcg/d administration was 5 days. We had no death related to FN. Ninety-three percent of all patients completed the treatment programmed. Conclusions: We have found a higher rate of FN with hospitalization (31%), in contrast with the hematologic toxicity reported preveously by US Oncology Group. The use of growth factor was able to prevent most of further hospitalization and mantain dose-intensity. G-CSF prophylaxis should be used in patients receiving adjuvant TC. No significant financial relationships to disclose.