Is there a role for prophylactic G-CSF in breast cancer patients receiving docetaxel chemotherapy in combination with carboplatin or cyclophosphamide?


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Alison Stillie1,Ellie Dickson2,Frances Yuille1
1NHS Lothian,2College of Medicine, University of Edinburgh

Abstract

Background

Neutropenic sepsis is a serious and life threatening complication of cyctotoxic chemotherapy.  Prophylactic granulocyte-colony stimulating factor (G-CSF) is considered under departmental policy if the risk of neutropenic sepsis is greater than 20% or the patient has significant risk factors including prior chemotherapy.  In this department prophylactic G-CSF is not routinely administered for breast cancer patients receiving docetaxel chemotherapy in combination with carboplatin (TCarbo) or cyclophosphamide (TC).  The aim of this project was to measure the incidence of neutropenic sepsis in patients receivig TC or TCarbo regimens and determine whether there is evidence to support the role of prophylactic G-CSF in this patient group.

Method

The medical records of all patients receiving this combination of chemotherapy from January 2012 - December 2014 were reviewed retrospectively to record the incidence of neutropenic sepsis.  Patients receiving primary G-CSF prophylaxis were excluded from the final analysis.

Results

46 patients were treated with these regimens of which 14 (30.4%) were excluded as they received primary G-CSF prophylaxis (13 prior chemotherapy; 1 auto immune pancytopenia).  32 patients were included in the analysis.  25 patients treated with TC, 12 (48%) required admission for the management of neutropenic sepsis.  7 patients received TCarbo, of whom 3 (42.9%) developed neutropenic sepsis.

Conclusion

The incidence of neutropenic sepsis in patients not receiving primary G-CSF prophylaxis is high.  There is evidence to support the role of primary prophylaxis with G-CSF fpr all patients receinving TC or TCarbo chemotherapy regimens.