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Fernandes R, Mazzarello S, Stober C, Ibrahim MF, Dudani S, Perdrizet K, Majeed H, Vandermeer L, Shorr R, Hutton B, Fergusson D, Gyawali B, Clemons M. Primary Febrile Neutropenia Prophylaxis for Patients Who Receive FEC-D Chemotherapy for Breast Cancer: A Systematic Review. J Glob Oncol 2018; 4:1-8. [PMID: 30241156 PMCID: PMC6180804 DOI: 10.1200/jgo.2016.008540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite widespread use of fluorouracil, epirubicin, cyclophosphamide, docetaxel (FEC-D) chemotherapy in breast cancer, the optimal strategy for primary febrile neutropenia (FN) prophylaxis remains unknown. A systematic review was therefore performed. METHODS Embase, Ovid MEDLINE, PubMed, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, and conference proceedings were searched from 1946 to April 2016 for trials that reported the effectiveness of primary FN prophylaxis with FEC-D chemotherapy. Outcome measures were incidence of FN; treatment-related hospitalizations; chemotherapy dose delays, reductions, and discontinuations; and adverse events from prophylaxis. RESULTS Of 2,205 identified citations, eight studies (n = 1,250) met our eligibility criteria. Three additional studies (n = 293) were identified from a prior systematic review. Three randomized controlled trials (n = 576), one phase IV single-arm trial (n = 69), one prospective observational study (n = 37), and six retrospective studies (n = 861) were identified. Agents investigated were pegfilgrastim (n = 108), filgrastim (n = 1,119), and ciprofloxacin (n = 89). The heterogeneity of studies meant that a narrative synthesis of results was performed. Median FN rates for patients who received FEC-D with and without primary prophylaxis were 10.1% (interquartile range [IQR], 3.9% to 22.6%) and 23.9% (IQR, 9.2% to 27.3%), respectively. In the absence of primary prophylaxis, FN was more common during docetaxel than during FEC. Data from six studies showed a median rate of dose reductions and delays of 6.1% (IQR, 3.1% to 14.3%) and 19.3% (IQR, 10.5% to 32.8%), respectively, that occurred as a consequence of FN. Toxicity from prophylaxis itself was rarely reported. CONCLUSION Primary FN prophylaxis is effective in patients who receive FEC-D chemotherapy. The paucity of prospective data makes optimal recommendations about the choice and timing of prophylaxis challenging.
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Affiliation(s)
- Ricardo Fernandes
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Sasha Mazzarello
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Carol Stober
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Mohamed F.K. Ibrahim
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Shaan Dudani
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Kirstin Perdrizet
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Habeeb Majeed
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Lisa Vandermeer
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Risa Shorr
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Brian Hutton
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Dean Fergusson
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Bishal Gyawali
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
| | - Mark Clemons
- Ricardo Fernandes, Mohamed F.K. Ibrahim,
Shaan Dudani, Kirstin Perdrizet, Habeeb
Majeed, and Risa Shorr, The Ottawa Hospital;
Ricardo Fernandes, Shaan Dudani, Kirstin
Perdrizet, Habeeb Majeed, Brian Hutton,
Dean Fergusson, and Mark Clemons, University of
Ottawa; Sasha Mazzarello, Carol Stober, Lisa
Vandermeer, Brian Hutton, Dean Fergusson,
and Mark Clemons, Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada; and Bishal Gyawali, Nobel Hospital, Sinamangal,
Kathmandu, Nepal
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Bacrie J, Laurans M, Iorio P, Fourme E, Volters AB, Bozec L, Lerebours F, Dubot C, Bensaoula O, Benzidane B, Pierga JY, Lefeuvre D. Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution. Support Care Cancer 2018; 26:4097-4103. [PMID: 29855772 DOI: 10.1007/s00520-018-4280-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Febrile neutropenia (FN) is one of the most common and most critical adverse effects of chemotherapy. Despite many existing guidelines based on the use of granulocyte-colony stimulating factor (G-CSF), FN continues to impair the quality of life and interfere with the treatment of many patients. The purpose of this study was to assess the incidence and management of FN associated with chemotherapy for early breast cancer in routine clinical practice. METHODS All patients with early-stage breast cancer (ESBC) treated by chemotherapy at Institut Curie, Hôpital René Huguenin, in 2014 were retrospectively included. The incidence and management of FN were reported. Risk factors associated with FN were studied by robust-error-variance Poisson regression. RESULTS A total of 524 patients received either neoadjuvant (N = 130) or adjuvant chemotherapy (N = 394). Most patients (80%) were treated with a combination of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC100; 3 cycles) followed by docetaxel 100 mg/m2 (D; 3 cycles). The overall incidence of FN was 17%. Eighteen percent of patients received primary prophylaxis (PP) for FN with G-CSF, using pegfilgrastim in 64% of cases and 74% of patients over the age of 70 received PP. Less than 5% of patients who received PP experienced FN. Recurrent FN after secondary prophylaxis was observed in 9% of patients. Forty-seven percent of cases of FN occurred after the first cycle and 30% occurred after the fourth cycle, corresponding to D ± trastuzumab (T). The FEC100 regimen was associated with a relative risk of FN of 1.98 (p = 0.09). Autoimmune (AI) and inflammatory diseases were associated with a higher risk of FN (RR 3.08; p < 0.01). No significant difference in the incidence of FN was observed between adjuvant and neoadjuvant chemotherapy. FN was managed on an outpatient basis in 72% of cases. Outpatients with FN were mainly treated by a combination of amoxicillin-clavulanic acid and ciprofloxacin. Dose reduction or chemotherapy regimen modification were necessary in 25% of patients after FN. No toxic death was reported. CONCLUSION The incidence of FN induced by adjuvant/neoadjuvant chemotherapy in ESBC is higher in routine clinical practice than in clinical trials. AI or inflammatory diseases were significant independent risk factors for FN. Primary prophylaxis in patients at risk (elderly, comorbid patients), especially treated with the FEC regimen, is the keystone of management of this adverse effect. Prevention and management of FN to ensure the patient's safety and quality of life are a major issue for both medical oncologists and supportive care physicians.
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Affiliation(s)
- Joy Bacrie
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France.
| | - Marc Laurans
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | - Pauline Iorio
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | | | | | - Laurence Bozec
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | | | - Coraline Dubot
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
| | - Okba Bensaoula
- Institut Curie, Hôpital René Huguenin, Saint Cloud, France
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