Routine prophylactic granulocyte colony stimulating factor (GCSF) is not necessary with accelerated (dose dense) paclitaxel for early breast cancer

Abstract

Prophylactic granulocyte colony stimulating factor (GCSF) is recommended with accelerated adjuvant chemotherapy but is expensive and causes bone pain. We have reviewed a series of patients with early breast cancer treated with accelerated 2-weekly paclitaxel without routine GCSF to assess its need. Patients receiving accelerated (dose dense) paclitaxel 175 mg/m2 2 weekly for 4 courses as adjuvant/neoadjuvant treatment for early breast cancer were treated electively without prophylactic GCSF, and monitored for absolute neutrophil count (ANC) before each cycle, grade and duration of neutropenia, incidence of neutropenic sepsis, treatment delays and requirements for secondary GCSF. Results were compared with prior patients given prophylactic GCSF. Of the 61 patients, 42 (69%) did not require prophylactic GCSF. Mild/moderate neutropenia was more common than in the prior group given GCSF, but secondary GCSF was required in only 6 (10%) patients due to grade 3 neutropenia and in 12 (20%) with grade 2 neutropenia. There were no episodes of neutropenic sepsis and no dose reduction or treatment delay was required. Accelerated paclitaxel in breast cancer patients without prophylactic GCSF is safe, avoids side effects, reduces costs and is not associated with an increase risk of neutropenic sepsis or treatment delays.