Incidence of Febrile Neutropenia in Advanced Breast Cancer Patients Receiving Adjuvant Docetaxel-Doxorubicin-Cyclophosphamide Chemotherapy in Korea and Its Impact on Prognosis

Abstract

Purpose: The concurrent regimen of docetaxel, doxorubicin, and cyclophosphamide (TAC) has been categorized as a high-risk factor for febrile neutropenia (FN). The incidence of FN was reported to be as high as 17%-26% in studies conducted in Western countries. However, these rates may vary among different ethnic groups. This study aimed to evaluate the incidence of FN and its effect on prognosis following adjuvant TAC chemotherapy in Korean patients with advanced breast cancer. Methods: We analyzed data from 187 patients who received 6 cycles of adjuvant TAC chemotherapy between July 2005 and December 2014. No patients received long-acting granulocyte-colony stimulating factor (G-CSF) as primary prophylaxis for FN due to guidelines for cost reimbursement in Korea. The incidence rates of FN, dose reduction of TAC, relative dose intensity (RDI), relapse-free survival (RFS), and overall survival (OS) were investigated. Results: A total of 102 (54.5%) patients experienced FN, especially older patients (51 years vs. 49 years, p= 0.045). RDI was lower in patients with FN than in those without (96.4% vs. 99.5%, p= 0.001, respectively). Death was reported in 2 patients (2.35%) without FN and in 10 patients (9.80%) with FN (hazard ratio [HR]: 6.64; 95% confidence interval [CI]: 1.28 to 34.36; p= 0.024). No significant differences in RFS (p= 0.235) were found using Kaplan-Meier analysis. Conclusion: The incidence of FN was significantly higher in Korea than in Western countries, and FN had a negative impact on the patients' prognosis. Primary prophylactic G-CSF should be prioritized in Korean patients with advanced breast cancer who receive adjuvant TAC chemotherapy.

Clinical Impact of Primary Prophylactic Pegfilgrastim in Breast Cancer Patients Receiving Adjuvant Docetaxel-Doxorubicin-Cyclophosphamide Chemotherapy

“…Previous studies conducted in Western countries reported that the overall incidence of FN during adjuvant TAC chemotherapy was 17%–26% [ 8 10 11 23 ], and clinical guidelines have categorized this regimen as conferring a high risk (> 20%) of FN [ 13 14 15 ]. However, the overall frequency of FN in Korean breast cancer patients receiving adjuvant TAC chemotherapy was a significantly higher than that in patients in previous studies conducted in Western countries (42.5%–63.4% vs. 17%–26%) [ 18 19 20 ]. Ethnic differences in hematologic toxicity from the TAC regimen are associated with inter-individual and inter-ethnic variations of docetaxel and doxorubicin pharmacokinetics or pharmacodynamics due to genetic differences [ 24 25 ].…”

“…Previous studies conducted in Korea reported that the overall frequency of FN during adjuvant TAC chemotherapy was significantly higher than that observed in previous studies conducted in Western countries (42.5%–63.4% vs. 17%–26%) [ 18 19 20 ]. However, only 1 study with a small sample size reported the clinical effect of primary prophylactic therapy using pegfilgrastim on the incidence of FN during adjuvant TAC chemotherapy in Korea [ 21 ].…”

Analisis Cost Consequences Obat Kemoterapi pada Pasien Kanker Payudara di RS Pemerintah Kota Yogtakarta

“…Hasil penelitian Zhou et al, (2017) menunjukkan bahwa terjadi efek samping berupa neutropenia akibat penggunaan regimen kemoterapi paclitaxel+platinum sebanyak 51 pasien (38,9%) dari total 131 pasien. Park et al, (2019) juga membuktikan bahwa regimen kemoterapi adjuvan taxan+antrasiklin pada ca mammae dapat menginduksi terjadinya efek samping berupa neutropenia. Total 102 pasien dalam penelitian tersebut mengalami efek samping berupa neutropenia sebanyak 64 pasien (62,8%).…”