B75
Comparison of rates of febrile neutropaenia using FEC100/Docetaxel100 chemotherapy in breast cancer patients with and without primary GCSF prophylaxis
Satyen Gohil, Anand Sharma, Catherine Harper-Wynne
Kent Oncology Centre, Maidstone Hospital, Maidstone, UK
Background
The adjuvant treatment of node positive breast cancer is increasingly incorporating the use of 3 cycles of FEC followed by three cycles of 100mg/m2 docetaxel as per the PACS-01 trial. This regimen significantly improves DFS and OS but is associated with higher rates of febrile neutropaenia (FN). Here, we compare the rates of FN with and without primary GCSF prophylaxis in patients receiving FEC/Docetaxel chemotherapy.
Method and Results
27 patients were identified who received FEC/Docetaxel chemotherapy without primary GCSF prophylaxis, out of whom 12 (46%) developed febrile neutropaenia, compared with the published rate of 11% seen in PACS-01.
We use a lower neutrophil threshold to commence each cycle of chemotherapy (1.0 as opposed to 1.5 in PACS-01) to avoid dose delays and reductions in chemotherapy efficacy. Analysis has shown that our lower neutrophil threshold was not responsible for the higher rates of FN seen.
Based on the above data we recommended the use of primary GCSF prophylaxis from cycle one of treatment. 35 patients who received primary prophylaxis were subsequently analysed, out of whom only 3 developed FN (8.6%). Further analysis revealed all 3 patients presented around the 8th day following the first docetaxel cycle.
Discussion and Conclusion
The rates of FN decreased from 46% to 8.6% with the use of primary GCSF prophylaxis with few side effects. The 3 FN episodes occurred during the first docetaxel chemotherapy cycle; thought to be de to the late neutropaenic nadir caused by FEC combined with the early nadir caused by docetaxel. Daily GCSF was usually given from days 5-10; however this will require review as we believe this may be too short and late.
Primary GCSF prophylaxis should be standard for all patients receiving FEC/Docetaxel chemotherapy as per PACS-01, leading to fewer episodes of FN, inpatient hospitalisations, dose reductions and delays.
