Febrile neutropenia in FEC-D regimen for early stage breast cancer: Is there a place for G-CSF primary prophylaxis?

Miguel, I.; Winckler, P.; Sousa, Mónica; Cardoso, Catarina; Moreira, A.; Brito, Margarida

doi:10.3233/bd-150411

Cited by 5 publications

(13 citation statements)

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“…Reasons for study exclusion during stage 2 screening were absence of FEC-D chemotherapy use (n = 32), lack of individual results within the breast cancer population (n = 8), systematic review/review article (n = 5), absence of FN data (n = 3), metastatic breast cancer (n = 3), economic analysis (n = 2), multiple chemotherapy regimens used (n = 2), secondary FN prophylaxis (n = 2), no G-CSF or antibiotics interventions (n = 1), duplicate publication (n = 1), and non–breast cancer study (n = 1). Of the 11 included studies, eight were available as peer-reviewed manuscripts 16 - 21 , 24 , 25 and three were available as meeting abstracts. 22 , 23 , 26 The studies were published in 1998, 23 2003, 22 2008, 24 2009, 21 2010, 19 , 20 , 25 2011, 26 2012, 18 2013, 17 and 2015.…”

Section: Resultsmentioning

confidence: 99%

“… 22 , 23 , 26 The studies were published in 1998, 23 2003, 22 2008, 24 2009, 21 2010, 19 , 20 , 25 2011, 26 2012, 18 2013, 17 and 2015. 16 …”

Section: Resultsmentioning

confidence: 99%

“…Sample sizes ranged from 32 19 to 448 22 patients. Pegfilgrastim was evaluated in two studies (n = 108), 20 , 21 filgrastim in seven (n = 1,119), 16 , 17 , 22 - 26 and ciprofloxacin in one (n = 89). 23 None of the included studies reported use of interim neutrophil counts to guide G-CSF dosing.…”

Section: Resultsmentioning

confidence: 99%

“… 20 Two studies provided detailed information about the use of primary prophylactic filgrastim. 16 , 17 One trial demonstrated that of 100 patients treated with FEC-D, 26% and 10% had FN without and with filgrastim prophylaxis, respectively. 17 In the other study, with a cohort of 189 patients treated with FEC-D, filgrastim was used in 1.8% and 9% during the FEC and docetaxel phases, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…17 In the other study, with a cohort of 189 patients treated with FEC-D, filgrastim was used in 1.8% and 9% during the FEC and docetaxel phases, respectively. 16 …”

Section: Resultsmentioning

confidence: 99%

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Primary Febrile Neutropenia Prophylaxis for Patients Who Receive FEC-D Chemotherapy for Breast Cancer: A Systematic Review

Fernandes

Mazzarello

Stober

et al. 2018

JGO

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PurposeDespite widespread use of fluorouracil, epirubicin, cyclophosphamide, docetaxel (FEC-D) chemotherapy in breast cancer, the optimal strategy for primary febrile neutropenia (FN) prophylaxis remains unknown. A systematic review was therefore performed.MethodsEmbase, Ovid MEDLINE, PubMed, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, and conference proceedings were searched from 1946 to April 2016 for trials that reported the effectiveness of primary FN prophylaxis with FEC-D chemotherapy. Outcome measures were incidence of FN; treatment-related hospitalizations; chemotherapy dose delays, reductions, and discontinuations; and adverse events from prophylaxis.ResultsOf 2,205 identified citations, eight studies (n = 1,250) met our eligibility criteria. Three additional studies (n = 293) were identified from a prior systematic review. Three randomized controlled trials (n = 576), one phase IV single-arm trial (n = 69), one prospective observational study (n = 37), and six retrospective studies (n = 861) were identified. Agents investigated were pegfilgrastim (n = 108), filgrastim (n = 1,119), and ciprofloxacin (n = 89). The heterogeneity of studies meant that a narrative synthesis of results was performed. Median FN rates for patients who received FEC-D with and without primary prophylaxis were 10.1% (interquartile range [IQR], 3.9% to 22.6%) and 23.9% (IQR, 9.2% to 27.3%), respectively. In the absence of primary prophylaxis, FN was more common during docetaxel than during FEC. Data from six studies showed a median rate of dose reductions and delays of 6.1% (IQR, 3.1% to 14.3%) and 19.3% (IQR, 10.5% to 32.8%), respectively, that occurred as a consequence of FN. Toxicity from prophylaxis itself was rarely reported.ConclusionPrimary FN prophylaxis is effective in patients who receive FEC-D chemotherapy. The paucity of prospective data makes optimal recommendations about the choice and timing of prophylaxis challenging.

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Section: Resultsmentioning

confidence: 99%

“… 22 , 23 , 26 The studies were published in 1998, 23 2003, 22 2008, 24 2009, 21 2010, 19 , 20 , 25 2011, 26 2012, 18 2013, 17 and 2015. 16 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…17 In the other study, with a cohort of 189 patients treated with FEC-D, filgrastim was used in 1.8% and 9% during the FEC and docetaxel phases, respectively. 16 …”

Section: Resultsmentioning

confidence: 99%

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Primary Febrile Neutropenia Prophylaxis for Patients Who Receive FEC-D Chemotherapy for Breast Cancer: A Systematic Review

Fernandes

Mazzarello

Stober

et al. 2018

JGO

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Chemotherapeutic Protocols for the Treatment of Breast Cancer

Cavalcanti

2022

Chemotherapy Protocols and Infusion Sequence

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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

Bacrie

Laurans

Iorio

et al. 2018

Support Care Cancer

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The incidence of FN induced by adjuvant/neoadjuvant chemotherapy in ESBC is higher in routine clinical practice than in clinical trials. AI or inflammatory diseases were significant independent risk factors for FN. Primary prophylaxis in patients at risk (elderly, comorbid patients), especially treated with the FEC regimen, is the keystone of management of this adverse effect. Prevention and management of FN to ensure the patient's safety and quality of life are a major issue for both medical oncologists and supportive care physicians.

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Febrile neutropenia in FEC-D regimen for early stage breast cancer: Is there a place for G-CSF primary prophylaxis?

Abstract: G-CSF prophylaxis is recommended for chemotherapy regimens associated with a FN rate higher than 20%. Based on our FN rates, we now recommend primary G-CSF prophylaxis during the administration of cycles 4 to 6 in FEC-D.

Cited by 5 publications

References 0 publications

Primary Febrile Neutropenia Prophylaxis for Patients Who Receive FEC-D Chemotherapy for Breast Cancer: A Systematic Review

Primary Febrile Neutropenia Prophylaxis for Patients Who Receive FEC-D Chemotherapy for Breast Cancer: A Systematic Review

Chemotherapeutic Protocols for the Treatment of Breast Cancer

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

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