Very low rates of neutropenic complications and chemotherapy dose modifications in early breast cancer patients receiving adjuvant FEC-100 or TAC and an individualised G-CSF and anti-infective support: results of a retrospective chart review
PURPOSE: Granulocyte-colony stimulating factors (G-CSFs) can effectively protect cancer patients receiving chemotherapy from neutropenic complications. To increase the efficacy, an individualised algorithm for the administration of G-CSF and anti-infectives was developed. Its impact on the neutropenic complications and entailed dose modifications in breast cancer patients receiving FEC-100 or TAC was evaluated.
PATIENTS AND METHODS: Supportive therapy comprised G-CSF (filgrastim, lenograstim or pegfilgrastim), antibiotics and antimycotics. During each chemotherapy cycle, leukocyte/granulocyte counts were repeatedly evaluated and the type, dosing and application frequency of supportive therapies immediately adjusted as soon as the cell counts changed. Medical charts of early breast cancer patients who had received FEC-100 or TAC and supportive therapy according to the individualised protocol between 2004 and 2009, were retrospectively evaluated at the Oncology Department of the General Hospital Klagenfurt, Austria. RESULTS: Sixty-two FEC-100 and 56 TAC patients were evaluated. Of the 696 chemotherapy cycles, 693 included G-CSF support. Overall proportions of cycles with grade 4 neutropenia (FEC-100, 1.7%; TAC, 1.2%) and febrile neutropenia (FN) (FEC-100, 1.7%; TAC, 0.9%) as well as dose reductions (FEC-100, 0.6%; TAC, 1.5%) and delays (FEC-100, 4.2%; TAC, 5.1%) were very low. This was true also for elderly patients (>50 years). No patient developed FN in the first cycle. Although more toxic, TAC was associated with less neutropenic complications than FEC-100.
CONCLUSION: Close-meshed monitoring of leukocyte/granulocyte counts and immediate adjustment of dosing and application frequencies of G-CSF and anti-infectives, also during the chemotherapy cycles, are highly effective in preventing neutropenic complications and their consequences in the clinical practice.