Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution

Bacrie, Joy; Laurans, M.; Iorio, P.; Fourme, Emmanuelle; Volters, Anne; Bozec, Laurence; Lerebours, Florence; Dubot, Coraline; Bensaoula, Okba; Benzidane, B.; Pierga, Jean‐Yves; Lefeuvre, D.

doi:10.1007/s00520-018-4280-4

Cited by 6 publications

(11 citation statements)

References 23 publications

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“…However, the incidence of CIN or FN is highest after the first course of chemotherapy, with a decreasing trend as the number of courses increases. This pattern corroborated the available evidence in the literature [25,27] and this may be attributed to the introduction of GCSF in subsequent cycles of chemotherapy. Hence, the use of GCSF should not only be commenced after the development of CIN or FN but on the initiation of chemotherapy and subsequently based on the patient's risk category.…”

Section: Discussionsupporting

confidence: 91%

“…The PRAXIS prospective multicentre study observed a 4.3% incidence of FN among 734 patients [22] and a European multinational neutropenia study that included 444 breast cancer patients reported an FN incidence of 6% [23]. Other recent single centre studies have even reported much higher values, with one Brazilian group reporting as high as a 63.3% [24] incidence of CIN (N = 79), a study from France with 524 breast cancer patients reported a 17% incidence of FN [25] and a UK study of 325 patients showing a 19% incidence of FN [26]. The risk of developing neutropenia during chemotherapy increased significantly with age, ECOG performance score of >1 and bone metastasis.…”

Section: Discussionmentioning

confidence: 97%

“…Other previously reported risk factors include lower BMI, higher doses, lower baseline white cell count, advanced disease, comorbidities and genetic factors [31][32][33]. There is overwhelming evidence on the efficacy of GCSF as prophylaxis for CIN and FN [25,34,35]. In a retrospective cohort study done in the United States, Weycker et al [34] observed that almost half of all FN hospitalisations occurred in patients who did not receive GCSF prophylaxis in that cycle compared to only 8.8% among those who received.…”

Section: Discussionmentioning

confidence: 99%

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Chemotherapy induced neutropenia and febrile neutropenia among breast cancer patients in a tertiary hospital in Nigeria

Salako

Okunade

Adeniji

et al. 2021

ecancer

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This study assessed the incidence of chemotherapy-induced neutropenia and febrile neutropenia (FN) while identifying their associated factors. Methods: A prospective cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a 2-year period. Socio-demographic, clinical and haematological data were obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected 2 weeks after each course of chemotherapy. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 was used to assess FN, neutropenia and their severity. Results: The incidence of neutropenia and FN among the patients was 31.9% and 5.3%, respectively. Throughout all courses of chemotherapy (n = 502), there were 57 (11.4%) neutropenic episodes with 6.6% mild, 3.4% moderate and 1.4% severe neutropenia. The incidence of neutropenia decreased with increasing chemotherapy courses, with a rate of 14.2% and 4.9% after the first and last course, respectively. Factors associated with the risk of developing neutropenia include increasing age (p = 0.014), Eastern Cooperative Oncology Group performance score ≥ 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). Conclusion: One in three breast cancer patients in this study developed neutropenia while on chemotherapy but no independent risk factors were identified for FN among these patients. This study has, therefore, provided the preliminary data necessary for further independent validation of the identified risk factors for FN in a more robust and well-designed study within our clinical practice setting in Nigeria.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Chemotherapy induced neutropenia and febrile neutropenia among breast cancer patients in a tertiary hospital in Nigeria

Salako

Okunade

Adeniji

et al. 2021

ecancer

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“…[1][2][3][4][5] Primary prophylaxis is recommended for all patients receiving chemotherapy associated with high (.20%) FN risk and considered for use with chemotherapy associated with intermediate (10%-20%) FN risk. [6][7][8] Overall reported FN rates are 17% in patients with early-stage breast cancer 9 and 13.1% in patients with newly diagnosed breast, colorectal, lung, lymphoid, or ovarian cancer. 10 However, with G-CSF primary prophylaxis, the FN rate is ,5%.…”

Section: Introductionmentioning

confidence: 99%

“…10 However, with G-CSF primary prophylaxis, the FN rate is ,5%. 9 Despite the high costs associated with G-CSF administration, use of G-CSFs is cost saving, and G-CSFs are a critical part of cancer therapy. 11 Thus, biosimilar availability in the United States was anxiously awaited.…”

Section: Introductionmentioning

confidence: 99%

BBCIC Research Network Analysis of First-Cycle Prophylactic G-CSF Use in Patients Treated With High–Neutropenia Risk Chemotherapy

Pawloski

McDermott²,

Marshall

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: Chemotherapy-induced febrile neutropenia (FN) is prevented or minimized with granulocyte colony-stimulating factors (G-CSFs). Several G-CSF biosimilars are approved in the United States. The Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) is a nonprofit initiative whose objective is to provide scientific evidence on real-world use and comparative safety and effectiveness of biologics and biosimilars using the BBCIC distributed research network (DRN). Patients and Methods: We describe real-world G-CSF use in patients with breast or lung cancer receiving first-cycle chemotherapy associated with high FN risk. We assessed hospitalizations for FN, availability of absolute neutrophil counts, and G-CSF–induced adverse events to inform future observational comparative effectiveness studies of G-CSF reference products and their biosimilars. A descriptive analysis of 5 participating national health insurance plans was conducted within the BBCIC DRN. Results: A total of 57,725 patients who received at least one G-CSF dose were included. Most (92.5%) patients received pegfilgrastim. FN hospitalization rates were evaluated by narrow (<0.5%), intermediate (1.91%), and broad (2.99%) definitions. Anaphylaxis and hyperleukocytosis were identified in 1.15% and 2.28% of patients, respectively. This analysis provides real-world evidence extracted from a large, readily available database of diverse patients, characterizing G-CSF reference product use to inform the feasibility of future observational comparative safety and effectiveness analyses of G-CSF biosimilars. We showed that the rates of FN and adverse events in our research network are consistent with those reported by previous small studies. Conclusions: Readily available BBCIC DRN data can be used to assess G-CSF use with the incidence of FN hospitalizations. Insufficient laboratory result data were available to report absolute neutrophil counts; however, other safety data are available for assessment that provide valuable baseline data regarding the effectiveness and safety of G-CSFs in preparation for comparative effectiveness studies of reference G-CSFs and their biosimilars.

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Real-world evaluation of supportive care using an electronic health record text-mining tool: G-CSF use in breast cancer patients

Laar

Gombert-Handoko

Wassenaar

et al. 2022

Support Care Cancer

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Purpose Chemotherapy-induced febrile neutropenia (FN) is a life-threatening and chemotherapy dose-limiting adverse event. FN can be prevented with granulocyte-colony stimulating factors (G-CSFs). Guidelines recommend primary G-CSF use for patients receiving either high (> 20%) FN risk (HR) chemotherapy, or intermediate (10–20%) FN risk (IR) chemotherapy if the overall risk with additional patient-related risk factors exceeds 20%. In this study, we applied an EHR text-mining tool for real-world G-CSF treatment evaluation in breast cancer patients. Methods Breast cancer patients receiving IR or HR chemotherapy treatments between January 2015 and February 2021 at LUMC, the Netherlands, were included. We retrospectively collected data from EHR with a text-mining tool and assessed G-CSF use, risk factors, and the FN and neutropenia (grades 3–4) and incidence. Results A total of 190 female patients were included, who received 77 HR and 113 IR treatments. In 88.3% of the HR regimens, G-CSF was administered; 7.3% of these patients developed FN vs. 33.3% without G-CSF. Although most IR regimen patients had ≥ 2 risk factors, only 4% received G-CSF, of which none developed neutropenia. However, without G-CSF, 11.9% developed FN and 31.2% severe neutropenia. Conclusions Our text-mining study shows high G-CSF use among HR regimen patients, and low use among IR regimen patients, although most had ≥ 2 risk factors. Therefore, current practice is not completely in accordance with the guidelines. This shows the need for increased awareness and clarity regarding risk factors. Also, text-mining can effectively be implemented for the evaluation of patient care.

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Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution

Cited by 6 publications

References 23 publications

Chemotherapy induced neutropenia and febrile neutropenia among breast cancer patients in a tertiary hospital in Nigeria

Chemotherapy induced neutropenia and febrile neutropenia among breast cancer patients in a tertiary hospital in Nigeria

BBCIC Research Network Analysis of First-Cycle Prophylactic G-CSF Use in Patients Treated With High–Neutropenia Risk Chemotherapy

Real-world evaluation of supportive care using an electronic health record text-mining tool: G-CSF use in breast cancer patients

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