Docetaxel and cyclophosphamide as adjuvant chemotherapy for early breast cancer: primary prophylaxis with G-CSF is required

Multicomponent nutritional supplement Oncoxin and its influence on quality of life and therapy toxicity in patients receiving adjuvant chemotherapy

Treatment of cancer often requires the use of adjuvant chemotherapy (ACT). In real clinical practice, numerous patients suffer from severe toxicity and reduced quality of life (QoL). Hence, there is a need to maintain QoL and to reduce therapy toxicity to comply with recommended chemotherapy (CT) regimens. The present study focused on the effects of the multi-component nutritional supplement Oncoxin (ONCX) on QoL and CT-induced toxicity in patients undergoing ACT. A total of 133 patients aged 50-70 years with gastric cancer IIB-IIIC or non-small cell lung cancer IIB-IIIA were enrolled in the present study: 84 received ONCX, and 49 were included in the control arm and received CT only. It was identified that after 2 weeks of treatment the patients receiving ONCX exhibited clinically meaningful improvement of QoL (measured by Edmonton Symptom Assessment System Questionnaire) compared with those in the control group (odds ratio, 2.07; 95% CI, 1.00-4.29). By the end of a 3 week-period, the albumin level was higher in patients of the ONCX group compared with those in the control group (mean, 38.1; 95% CI, 37.1-39.1 g/l; vs. mean, 35.5; 95% CI, 33.9-37.0; P=0.03; respectively). Furthermore, the use of ONCX substantively reduced the hepatic toxicity of ACT. The present prospective real clinical setting study revealed positive effects of ONCX on QoL and ACT toxicity. The present study was retrospectively registered under the study registration number NCT03550482 at ClinicalTrials.gov (June 8, 2018).

Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia

OBJECTIVE

To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer.

METHODS

Linked data from New South Wales population-based and clinical cancer registries (2008-2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18 years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6 months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods.

RESULTS

A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1).

CONCLUSION

Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols. Further examination of reasons for admission is needed to inform actions to improve patient safety.

Dose modifications in adjuvant chemotherapy for solid organ malignancies: A systematic review of clinical trials

Toxicities of systemic cancer therapies are often less frequently observed in clinical trials than in clinical practice, due to the careful selection of patients with fewer comorbidities. Although guidelines exist for the estimation of chemotherapy dose, clinical factors like age, comorbid illness and extremes of body habitus are not considered in the method of dose calculation, which can result in significant toxicity. We reviewed the referenced clinical trials from which the evidence-based curative-intent cancer treatment protocols were developed for EVIQ, which is an Australian government, online resource. This review shows that a significant proportion of patients in curative-intent clinical trials experience toxicities that result in dose modifications-dose reduction, dose delays or missed doses-despite strict selection criteria and intense monitoring. Thus, even in ideal, clinical-trial settings chemotherapy dose calculation remains imprecise and subject to adjustment as clinically appropriate. In real-world clinical practice, dose alterations or modifications in response to toxicities need to be thoroughly discussed and implemented with clear understanding of the patient with appropriate documentation. This review may be used as a reference in these situations to elaborate the extent of toxicities seen in clinical trials with optimal settings.

High incidence of febrile neutropenia following adjuvant breast chemotherapy with docetaxel, carboplatin and trastuzumab

SUMMARY 

Aim: To determine the incidence of febrile neutropenia (FN) following adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH) for early-stage breast cancer and the grade of neutropenia after cycle one. Methods: A retrospective multicenter audit of patients with early-stage breast cancer treated with TCH, was conducted at four Australian hospitals between October 2009 and September 2013. Results: Of 79 patients analyzed, data from 78 women were evaluated for FN incidence and data from 64 women were evaluated for grade of neutropenia. After cycle one of TCH, 26 patients developed FN (33.3%). Following all cycles, 32 patients developed FN (41.0%). There was no statistical difference in the incidence of FN between hospitals or between age groups (above or below 65 years). After cycle one, ten patients developed grade 3 neutropenia (15.6%) and 37 patients developed grade 4 neutropenia (57.8%). Conclusion: This study demonstrates a high incidence of FN post-TCH chemotherapy thus supporting the use of granulocyte colony-stimulating factor as primary prophylaxis.

High incidence of febrile neutropenia seen following adjuvant chemotherapy with docetaxel plus cyclophosphamide for early breast cancer

A LETTER IN RESPONSE TO: Lakhanpal R, Stuart-Harris R, Chan A et al. Docetaxel and cyclophosphamide as adjuvant chemotherapy for early breast cancer: primary prophylaxis with G-CSF is required. Breast Cancer Manage. 2(5), 367–374 (2013).