SUMMARY  Aim: To determine the incidence of febrile neutropenia (FN) following adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH) for early-stage breast cancer and the grade of neutropenia after cycle one. Methods: A retrospective multicenter audit of patients with early-stage breast cancer treated with TCH, was conducted at four Australian hospitals between October 2009 and September 2013. Results: Of 79 patients analyzed, data from 78 women were evaluated for FN incidence and data from 64 women were evaluated for grade of neutropenia. After cycle one of TCH, 26 patients developed FN (33.3%). Following all cycles, 32 patients developed FN (41.0%). There was no statistical difference in the incidence of FN between hospitals or between age groups (above or below 65 years). After cycle one, ten patients developed grade 3 neutropenia (15.6%) and 37 patients developed grade 4 neutropenia (57.8%). Conclusion: This study demonstrates a high incidence of FN post-TCH chemotherapy thus supporting the use of granulocyte colony-stimulating factor as primary prophylaxis.

Retinal vein thrombosis is a common vascular occlusive disorder of the retina responsible for varying degrees of vision impairment. It is an adverse effect rarely associated with cancer and its treatment. We report the case of a patient with metastatic colon cancer who developed central retinal vein thrombosis (CRVT) in the right eye following two cycles of chemotherapy with capecitabine and oxaliplatin (XELOX) plus bevacizumab given prior to hepatic resection. Despite cessation of chemotherapy, vision has not improved. The etiology of the CRVT in this case is not clear due to risk factors for venous thrombotic events including colonic malignancy and previous major surgery. However, the proximity of chemotherapy administration to the initial development of symptoms suggests the possibility of a medication-related cause, with bevacizumab and capecitabine the most likely suspects.

Small-cell lung cancer accounts for approximately 13% of lung cancers diagnosed worldwide. The vast majority of patients are elderly and current or past heavy smokers. Cases rarely occur in the young or never-smokers. We report a case of a 21-year-old female who had never smoked and initially presented with a history of cough and exertional dyspnoea. Histology showed a small-cell neuroendocrine tumor and imaging confirmed extensive stage disease. Literature review found five other cases of small-cell lung cancer in patients under 30 years. This case highlights the need for international studies to determine genomic differences between the young and elderly and never-smokers and smokers to aid the development of new targeted therapies in this rare and difficult to treat malignancy.

A LETTER IN RESPONSE TO: Lakhanpal R, Stuart-Harris R, Chan A et al. Docetaxel and cyclophosphamide as adjuvant chemotherapy for early breast cancer: primary prophylaxis with G-CSF is required. Breast Cancer Manage. 2(5), 367–374 (2013).

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