Abstract
BackgroundThe use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The existence of a medical need for G-CSF primary and secondary prophylaxis with these regimens was investigated in a real-life setting.MethodsNine oncologists and six hematologists from different Belgian general hospitals and university centers were surveyed to collect expert opinion and real-life data (year 2007) on the use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the clinical management of FN in patients aged <65 years with breast cancer or NHL. Data were retrospectively obtained, over a 6-month observation period.ResultsThe most frequently used regimens in breast cancer patients (n = 161) were FEC (45%), FEC-T (37%) and docetaxel alone (6%). In NHL patients (n = 39), R-CHOP-21 (33%) and R-ACVBP-14 (15%) were mainly used. Without G-CSF primary prophylaxis (PP), FN occurred in 31% of breast cancer patients, and 13% had PSN. After G-CSF secondary prophylaxis (SP), 4% experienced further FN events. Only 1 breast cancer patient received PP, and did not experience a severe neutropenic event. Overall, 30% of chemotherapy cycles observed in breast cancer patients were protected by PP/SP. In 10 NHL patients receiving PP, 2 (20%) developed FN, whereas 13 (45%) of the 29 patients without PP developed FN and 3 (10%) PSN. Overall, 55% of chemotherapy cycles observed in NHL patients were protected by PP/SP. Impaired chemotherapy delivery (timing and/or dose) was reported in 40% (breast cancer) and 38% (NHL) of patients developing FN. Based on oncologist expert opinion, hospitalization rates for FN (average length of stay) without and with PP were, respectively, 48% (4.2 days) and 19% (1.5 days). Similar rates were obtained from hematologists.ConclusionsDespite the studied chemotherapy regimens being known to be associated with a moderate or high risk of FN, upfront G-CSF prophylaxis was rarely used. The observed incidence of severe neutropenic events without G-CSF prophylaxis was higher than generally reported in the literature. The impact on medical resources used is sizeable.
Highlights
The use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium
Several randomized controlled trials demonstrated a significant reduction in FN after systemic chemotherapy with the use of prophylactic G-CSF compared with untreated controls, and a recent meta-analysis on the proactive use of G-CSF as primary prophylaxis revealed a significant reduction in the risk of FN (RR = 0.54) and infection-related mortality (RR = 0.55) with this strategy, together with a significant increase in the relative dose intensity of the chemotherapy administered (+8.4% on average) [8]
Real-life data were collected for 161 breast cancer (969 cycles of chemotherapy observed) and 39 NHL patients (208 cycles)
Summary
The use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The absence of G-CSF prophylaxis was significantly associated with higher rate of FN and reduced relative dose-intensity in NHL patients from two retrospective studies [9,10]. Other studies, in both clinical trial and community settings, have demonstrated that FN events mainly occur during the first cycles of chemotherapy, thereby highlighting the importance of primary prophylaxis in patients at high risk for FN [11,12,13,14]
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