Impact of colony-stimulating factors to reduce febrile neutropenic events in breast cancer patients receiving docetaxel plus cyclophosphamide chemotherapy

Abstract

Our findings indicate that TC was associated with higher rates of FN than reported in the clinical trial. The 25% incidence fulfills the requirement of primary prophylaxis with G-CSF. Routine administration of G-CSF is highly recommended to reduce the rates of FN in breast cancer patients receiving TC.

The Cost–Utility of Adjuvant Chemotherapy Using Docetaxel and Cyclophosphamide Compared with Doxorubicin and Cyclophosphamide in Breast Cancer

“…We assumed twice the fn risk with tc than with ac and comparable base case utilities for both regimes during the treatment period. However, in clinical practice, tc chemotherapy is perhaps more commonly used in older patients and in those with node-negative disease, and it is associated with higher fn rates and possibly with lower treatment-related utility 27,[31][32][33] . Our cost-utility estimates in those practical scenarios, and in circumstances in which primary g-csf prophylaxis is considered for all patients, were less favorable than those in the primary analysis based on clinical trial data, although they remained within commonly used cost-utility thresholds 36,37 .…”

“…The base case scenario incorporated secondary prophylaxis with granulocyte colony-stimulating factor (g-csf) after fn events and assumed no chemotherapy dose adjustments. However, outside of clinical trials, use of tc appears to be associated with higher fn rates of approximately 26% (range: 10%-46%) without and 6% (range: 0%-7%) with primary g-csf prophylaxis 27,31,32,33 . Primary prophylaxis with g-csf is also sometimes used with the tc regimen in clinical practice, because it is recommended for chemotherapeutic regimens associated with a fn risk greater than 20% 34 .…”

Use and Delivery of Granulocyte Colony–Stimulating Factor in Breast Cancer Patients Receiving Neoadjuvant or Adjuvant Chemotherapy—Single-Centre Experience

“…In U.S. Oncology Trial 9735, which compared tc with ac (doxorubicin-cyclophosphamide) in the adjuvant therapy of early-stage breast cancer, both arms achieved rates of febrile neutropenia less than 10% 6 . However, several recent retrospective studies showed a higher rate of febrile neutropenia with tc (25%-50%) in the absence of primary prophylaxis 7,8 . The rate of febrile neutropenia associated with fecd has also been shown to be higher than previously thought.…”

Risk of Treatment Related Death and Febrile Neutropaenia with First Line Palliative Chemotherapy for De Novo Metastatic Breast Cancer in Clinical Practice in a Middle Resource Country

“…While in the adjuvant setting, clinicians and patients expect a low risk of FN and TRD, in the metastatic setting the expected rates should be higher as patients are either symptomatic or without further treatment can expect to become symptomatic soon and eventually die of metastatic disease. Reported FN rates in the literature from clinical trials for first line chemotherapy in MBC range from 4.9% to as high as 47.8% (Biganzoli et al, 2002;Alba et al, 2004;Conte et al, 2004;Cresta et al, 2004;Park et al, 2010;Tomova et al, 2010, Chan A et al, 2011. These rates differed according to different regimens and were the highest for regimens using combination chemotherapy rather than sequential treatment.…”

“…In fact, combination chemotherapy was shown to have a detrimental effect on progression free survival and increased rates of FN (Dear et al, 2013). The available data on TRD from clinical trials with chemotherapy for MBC range from 0.4% to 5.3% (Baker et al, 1974;Chlebowski et al, 1989;FESG, 2000;Biganzoli et al, 2002;Alba et al, 2004;Conte et al, 2004;Cresta et al, 2004;Park et al, 2010;Tomova et al, 2010, Chan A et al, 2011. Due to the paucity of data regarding the FN and TRD rates for de novo MBC especially in the clinical practice setting where we can expect a higher rate compared to clinical trial setting.…”