Toxicity and Tolerability Study of Adjuvant TAC Regimen Chemotherapy in Korean Patients with Breast Cancer

Clinical Impact of Primary Prophylactic Pegfilgrastim in Breast Cancer Patients Receiving Adjuvant Docetaxel-Doxorubicin-Cyclophosphamide Chemotherapy

Purpose

The regimen including concurrent docetaxel, doxorubicin, and cyclophosphamide (TAC) has been categorized as an important risk factor for febrile neutropenia (FN). This comparative study examined the clinical impact of long-acting granulocyte colony-stimulating factor (G-CSF) (pegfilgrastim) during adjuvant TAC chemotherapy in Korean patients with advanced breast cancer.

Methods

We analyzed data from 239 patients who received 6 cycles of adjuvant TAC chemotherapy. We categorized patients into 2 groups according to the use of primary prophylactic pegfilgrastim and compared the incidence and risk of FN, hospital care costs, and survival in the 2 groups.

Results

The incidence of FN decreased from 54.2% to 21.2% in all patients, after the use of pegfilgrastim. The analysis of a total of 1,432 chemotherapy cycles showed that the incidence of FN decreased from 36.1% to 9.1% after the use of pegfilgrastim. Moreover, the decrease in the incidence of FN with the use of pegfilgrastim resulted in a significant decrease in the mean duration of neutropenia (4.15 to 1.29 days), the risk of hospitalization (99.5% to 29.7%) and the mean total hospital care cost (USD 3,038 to USD 2,347). High relative dose intensity (RDI) in patients treated with pegfilgrastim than in those not treated with pegfilgrastim (99.18% vs. 93.85%) was associated with a better overall survival (p = 0.033).

Conclusions

The use of pegfilgrastim during adjuvant TAC chemotherapy was significantly associated with a decrease in the incidence and risk of FN, hospital care costs, and risk of death compared to the use of adjuvant TAC without primary prophylaxis.

Pegfilgrastim for primary prophylaxis of febrile neutropenia in breast cancer patients undergoing TAC chemotherapy

Purpose

Primary prophylaxis with granulocyte colony-stimulating factor can effectively prevent febrile neutropenia (FN) during breast cancer treatment. The aims of this study were to evaluate the incidence of FN and the ANC profile in patients undergoing chemotherapy and pegfilgrastim primary prophylaxis.

Methods

Patients receiving 6 cycles of adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) chemotherapy were included in this study. Pegfilgrastim was administered with analgesics 24 hours after treatment. Laboratory tests were performed on day 0 (before chemotherapy) and ANC was measured daily starting day 5 until it were restored to 1,000/mm³. Bone pain was checked via the numeral rating scale (NRS).

Results

A total of 61 patients and 366 cycles were evaluated. Mean age was 49.2 ± 7.1 years. FN was seen in 5 patients (16.4%) and 12 cycles (3.3%) with pegfilgrastim. Grades 3 and 4 neutropenia was seen in 91.5% of cycles with FN. The ANC nadir was most commonly seen at day 7 and the mean ANC nadir depth was 265.7/m³. Age was negatively correlated with nadir depth (r = −0.137, P = 0.009). Severe pain higher than NRS 7 occurred in less than 20% of patients after the administration of pegfilgrastim.

Conclusion

Incidence of FN was low during the chemotherapy by primary prophylaxis with pegfilgrastim. The ANC nadir was seen on day 7 after chemotherapy. Bone pain with pegfilgrastim was well tolerated during TAC chemotherapy.

Toxicity and quality of life of Korean breast cancer patients treated with docetaxel-containing chemotherapy without primary G-CSF prophylaxis

BACKGROUND

The aim of this study was to evaluate the toxicity and quality of life (QoL) of breast cancer patients treated with a docetaxel-containing chemotherapeutic regimen and to compare adriamycin and cyclophosphamide (AC) for four cycles followed by docetaxel (D) for four cycles with docetaxel, adriamycin, and cyclophosphamide (TAC) for six cycles without primary granulocyte colony-stimulating factor (G-CSF) prophylaxis.

METHODS

Node-positive breast cancer patients who received surgery from three hospitals were included. Subjects received docetaxel-containing chemotherapy and completed a questionnaire on QoL (EORTC QLQ-C30 and QLQ-BR23) at each cycle. Toxicity was assessed using the National Cancer Institute Common Toxicity Criteria.

RESULTS

All 78 eligible subjects and 542 cycles were analyzed. The incidence of dose reduction and grade 3 edema was higher in the AC-D group. The incidence of febrile neutropenia was significantly increased in the TAC group (63.4 %) compared to the AC-D group (29.7 %). Grade 3 or 4 anemia was higher in the TAC group, and grade 3 or 4 arthralgia was higher in the AC-D group. There were no significant differences in severe nausea and vomiting, fatigue, neuropathy, and peripheral edema. Baseline quality of life showed no difference between the two groups. The global health status decreased during chemotherapy and recovered to baseline level 3 months after chemotherapy.

CONCLUSION

Although the incidence of febrile neutropenia was high without primary G-CSF prophylaxis and was more severe in the TAC group, QoL revealed comparable results in both regimens; therefore, it could be one of the considerations in the choice of treatment strategy.