P5-18-05: Incidence of Febrile Neutropenia in Patients Treated with Docetaxel and Cyclophosphamide (TC) for Adjuvant Breast Cancer

Controversial issues in the management of older adults with early breast cancer

It is well recognized that the incidence of breast cancer increases significantly with age. Despite this, older people remain under-represented in many clinical trials and their management relies on extrapolation of data from younger patients. Providing an aggressive intervention can be challenging, particularly in less fit older patients where a conservative approach is commonly perceived to be more appropriate. The optimal management of this population is unknown and treatment decision should be personalized. This review article will discuss several controversial issues in managing older adults with early breast cancer in a multidisciplinary setting, including the role of surgical treatment of the axilla in clinically node negative disease, radiotherapy after breast conservation surgery in low-risk tumours, personalizing adjuvant systemic therapy, and geriatric assessments in breast cancer treatment decisions.

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

SUMMARY Aim: To determine the incidence of febrile neutropenia (FN) associated with the use of docetaxel and cyclophosphamide (TC) as adjuvant chemotherapy for early breast cancer (EBC) and also the grade of neutropenia after cycle 1 of TC. Methods: We conducted a multicenter retrospective audit of women with EBC treated with TC between January 2010 and July 2011, recruited from seven Australian centers. Results: Of a total of 368 previously untreated women with EBC who received TC, 300 were evaluable for FN and 304 were evaluable for neutropenia after cycle 1 of TC. Overall, 73 (24.3%) patients developed FN. The incidence of FN was highest after cycle 1 of TC and was significantly higher in women under 65 years of age (p = 0.007). There was significant variation in the incidence of FN between participating sites (p < 0.001). Eight patients (2.6%) developed grade 3 neutropenia and 191 patients (62.8%) developed grade 4 neutropenia. Conclusion: TC as adjuvant chemotherapy for EBC is associated with a 24.3% incidence of FN and a 65.4% incidence of grade 3 or 4 neutropenia. The high incidence of FN and severe neutropenia warrant the use of G-CSF as primary prophylaxis.