Primary prophylaxis (PP) among patients with early-stage breast cancer (ESBC) undergoing adjuvant/neoadjuvant chemotherapy prevents the incidence of febrile neutropenia in routine clinical practice, according to a study published in Supportive Care in Cancer

Febrile neutropenia is among one of the most common and serious complications associated with chemotherapy. Despite efforts to improve its incidence and outcomes, it continues to have negative impact on quality of life and treatment management. 

For this retrospective study, researchers assessed the outcomes of 524 patients with ESBC in 2014 at the Institut Curie, Hospital Rene Huguenin in France, of whom 130 and 394 received neoadjuvant or adjuvant chemotherapy, respectively. The majority of patients received 5-FU, epirubicin, plus cyclophosphamide (FEC100) followed by docetaxel. 

Results showed that overall, 17% of study patients developed febrile neutropenia. 

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Eighteen percent of patients (including 74% of those older than 70) received febrile neutropenia primary prophylaxis with granulocyte-colony stimulating factor (G-CSF), 64% of whom received pegfilgrastim. Less than 5% of patients who received primary prophylaxis developed febrile neutropenia. Recurrent febrile neutropenia post secondary prophylaxis occurred in 9% of patients. 

Approximately half (47%) of febrile neutropenia cases occurred after the first cycle of chemotherapy, and 30% occurred after the 4th, corresponding to docetaxel plus trastuzumab. 

The FEC100 regimen, autoimmune disease, and inflammatory disease were independently associated with increased relative risk of developing febrile neutropenia. The rate was not significantly different between patients in the neoadjuvant and adjuvant chemotherapy groups.

Seventy-two percent of febrile neutropenia cases were managed in the outpatient setting, and were treated with a combination of ciprofloxacin and amoxicillin-clavulanate. 

Twenty-five percent of patients needed to dose-reduce or modify their chemotherapy regimen after febrile neutropenia; no toxic deaths were observed among study participants. 

The authors concluded that “PP 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 [febrile neutropenia] to ensure the patient’s safety and quality of life are a major issue for both medical oncologists and supportive care physicians.”

Reference

Bacrie J, Laurans M, Iorio P, et al. Febrile neutropenia in adjuvant and neoadjuvant chemotherapy for breast cancer: a retrospective study in routine clinical practice from a single institution. Support Care Cancer. doi: 10.1007/s00520-018-4280-4