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

Lakhanpal et al. conducted a multicenter retrospective audit in seven Australian centers to determine the incidence of febrile neutropenia (FN) and neutropenia associated with the use of docetaxel plus cyclophosphamide (TC) in women with early breast cancer who did not receive primary prophylaxis with G-CSF or antibiotics [1]. Of the 300 evaluable female patients 73 (24.3%) developed FN with the incidence higher after cycle 1 of TC. FN was also significantly higher in women under 65 years of age. Of the 304 patients evaluated for neutropenia following cycle 1, 2.6% developed grade 3 neutropenia and 62.8% developed grade 4 neutropenia. Jones et al. in the US Oncology Trial comparing TC with doxorubicin plus cyclophosphamide reported a 5% incidence of FN with TC [2]. In addition to their audit, Lakhanpal et al. reviewed 14 additional studies, which gave a combined incidence of 26.5% (273 out of 1028 cases); well above the accepted 20% incidence for which primary prophylaxis with G-CSF is suggested [1].

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