Febrile neutropenia (FN) rates for FEC (100) – taxotere (FEC100-T)  chemotherapy in breast cancer: perspective from 2 cancer centres


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Ajay Aggarwal1, Nihal Shah2
1University College Hospital, London, UK, 2Mount Vernon Cancer Centre, Middlesex, UK

Background

In the UK sequential FEC/Taxotere is used as adjuvant or neoadjuvant treatment of lymph node positive or high risk breast cancer patients. However this regime is associated with an increased incidence of FN.

As per international guidance1,2 regimes prescribed with curative intent and have a FN rate greater than 20% are eligible for primary GCSF prophylaxis. FEC100-T is considered to have a 10-20% FN rate (11.2% in PACS-01 study3), although actual rates were considered higher. Retrospective audits were conducted at 2 cancer centres to determine FN rate in patients receiving FEC (100)-T over a 12 month period.

Method

Between Feb 2008-Feb 2009, 40 patients were treated with FEC (100)-T at the 1st centre and 47 patients at the 2nd centre. Baseline demographic data was collected including rates of FN, treatment delays, dose reduction and incidence of FN with primary or secondary GCSF prophylaxis.

Results

Audit 1: Mean age 48.8, FN rate – 50% of which 60% developed FN in the taxotere arm. Mean inpatient stay 5 days with 65% of these patients having a treatment delay. 10% receiving secondary prophylaxis had an additional episode of FN. No FN in primary prophylaxis group.

Audit 2: Mean age 53.5, FN rate - 28% of which 53% developed FN in the taxotere arm. Mean inpatient stay 4.3 days with 85% having a treatment delay of at least one week. A further 30% of patients developed Grade 3/4 neutropenia requiring a treatment delay. No further FN after primary or secondary prophylaxis.

Conclusion

Results from two different centres demonstrate the above regime is associated with clinically significant FN of rates greater than 20%, resulting in frequent hospital admissions, and delays to treatment. Primary GCSF prophylaxis has since been endorsed for all patients receiving FEC (100)-T chemotherapy in both networks.