The risk of febrile neutropenia and need for G-CSF primary prophylaxis with the docetaxel and cyclophosphamide regimen in early-stage breast cancer patients: a meta-analysis

Tran Do, Rohan Medhekar, Raksha Bhat, Hua Chen, Polly A. Niravath, Meghana V. Trivedi

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

The febrile neutropenia (FN) rates reported with the docetaxel 75 mg/m2 plus cyclophosphamide 600 mg/m2 (TC) regimen given every 3 weeks vary from 4 to 69 % in early-stage breast cancer (ESBC) patients. This creates uncertainty as to whether patients receiving the TC regimen should also receive granulocyte colony-stimulating factor primary prophylaxis (G-CSFpp), which is recommended when chemotherapy regimens have ≥20 % FN rate. We conducted a meta-analysis of published studies to determine FN rate with the TC regimen, its dependence on patients’ age, and the efficacy of G-CSFpp in reducing it in ESBC patients. We systematically searched the literature via PUBMED using the following terms: ‘docetaxel’, ‘cyclophosphamide’, ‘febrile neutropenia’, and ‘breast cancer’. Inclusion criteria were full text peer-reviewed clinical studies in English reporting FN rates with TC regimen in relationship to G-CSFpp. Comprehensive meta-analysis software was used for all statistical analyses. Eight studies (N = 1542 patients) were included in our meta-analysis. The pooled mean FN rate was 23.2 % (95 % confidence interval (CI) 6.9–55.2 %; Q = 218.17, I2 = 97.7). The FN risk in <65 years old patients was lower by 67.7 % compared to that in patients ≥65 years old (pooled odds ratio (OR) 0.323; 95 % CI 0.127–0.820; P = 0.017). The FN risk was reduced by 92.3 % with G-CSFpp (pooled OR 0.077; 95 % CI 0.013–0.460; P = 0.005). Our meta-analysis demonstrated that TC regimen was associated with ≥20 % FN risk, which was significantly higher in patients ≥65 years old and improved with G-CSFpp. G-CSFpp should be considered for all ESBC patients receiving TC regimen, especially those ≥65 years old.

Original languageEnglish (US)
Pages (from-to)591-597
Number of pages7
JournalBreast Cancer Research and Treatment
Volume153
Issue number3
DOIs
StatePublished - Oct 3 2015

Keywords

  • Breast cancer
  • Cyclophosphamide
  • Docetaxel
  • Febrile neutropenia
  • G-CSF
  • Primary prophylaxis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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