Prevalence of Febrile Neutropenia in Breast Cancer Patients Received Adjuvant Paclitaxel Treatment.

Abstract

OBJECTIVE: to review prevalence and risk factors of febrile neutropenia in breast cancer patients received adjuvant paclitaxel treatment. METHODS: retrospective chart review of 18 breast cancer patients received 146 cycles of adjuvant paclitaxel for prevention of breast cancer recurrence during 2011 at Phramongkutklao hospital, Bangkok, Thailand. RESULTS: Average age of patient in this study was 54.6+/-10.5 years old. Paclitaxel were given to patients in 7 dosage regimens. The most common dosage regimen (62/146, 42.5%) was weekly paclitaxel 12 cycles post doxorubicin and cylcophosphamide (AC) regimen. There were 3 febrile neutropenia cases out of 18 patients who received 146 cycles of adjuvant paclitaxel treatment. Prevalence of febrile neutropenia in this study was 2.05%. Prevalence of neutropenia in this study was 7.5% (11 cases out of 146 treatment cycles). Dosage regimen of paclitaxel (> 100 mg/m2 /cycle ) was found to associated with neutropenia. Other common adverse events found in this study were peripheral neuropathy in 9 cases (50%), nausea/vomiting 7 cases (29%) and muscle weakness 6 cases (25%). CONCLUSIONS: Neutropenia from higher dose (>100 mg/m2) of paclitaxel was common and trend to associated with febrile neutropenia in breast cancer patients treated with this drug. Closely monitoring and supportive therapy is needed in the patients recieving higher paclitaxel dose to prevent febrile nutropenia during adjuvant paclitaxel treatment. Rationale Paclitaxel is a fundamental drug for breast cancer treatment. It prolongs patients’ survival and prevents disease recurrence, either alone or in combination with other antinoeplastics. Despite its effectiveness, adverse effects such as hypersensitivity, peripheral neuropathy and bone marrow suppression are common and should be well monitored in patients received the treatment. Among several toxicities, febrile neutropenia can be fatal and should be studied to explore the prevalence and risk factors for improving the safety in patients who need paclitaxel treatment. Objectives To review the prevalence and risk factors associated with febrile neutropenia among breast cancer patients received adjuvant paclitaxel treatment in real practice setting. Methods This study was done by retrospective chart review in randomly selected accessible 18 patients received adjuvant paclitaxel treatment during year 2011. Results Discussion and Conclusion Prevalence of febrile neutropenia and neutropenia was 2.05% and 7.5%, respectively in this study. The prevalence of febrile neutropenia was relatively low when compare to similar studies. However, focusing on neutropenia, the prevalence of neutropenia in patients received AC/T regimen was comparative to similar study. We found lower prevalence of neutropenia (8.06% vs 10.34%) among patients received weekly paclitaxel compare to who received every 3 weeks paclitaxel which indicated impact of the dose on neutropenia adverse effect. When focusing to the dose of paclitaxel, the higher dose (>100 mg/m2 /cycle) was found to associated with higher prevalence of neutropenia. Therefore, close monitoring and supportive treatment are warranted for patient receiving paclitaxel especially in the high dose/cycle (> 100mg/m2).