Febrile Neutropenia-associated Hospitalization in Breast Cancer Patients on Docetaxel-containing Regimen: A Retrospective Cohort Study on Duration of Prophylactic GCSF Administration

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Abstract Summary
Abstract ID :
Submission Type
HA Staff
Authors (including presenting author) :
Lee CF(1,2), Zhou K(1), Young WM(2,3), Wong CS(4), Ng TY(4), Lee SF(4), Wong C(3,5), Wong KM(3,6), So KH(3,7), Leung NT(3,5), Tang K(3,8), Chong CH(3,8), Chan SK(3,9), Yip YTE(3,9), Ma YM(3,10), Yeung PH(10), Chin HY(10), Kwan MW(6), Tsang HT(6)
Affiliation :
(1) School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong (2) Department of Pharmacy, Tuen Mun Hospital, Hong Kong (3) COC Pharmaceutical Service - Oncology Working Group (4) Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (5) Department of Pharmacy, Queen Mary Hospital, Hong Kong (6) Department of Pharmacy, Queen Elizabeth Hospital, Hong Kong (7) Department of Pharmacy, Prince of Wales Hospital, Hong Kong (8) Department of Pharmacy, United Christian Hospital, Hong Kong (9) Department of Pharmacy, Princess Margaret Hospital, Hong Kong (10) Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital, Hong Kong
Introduction :
Granulocyte colony-stimulating factor (GCSF) was recommended for docetaxel treatment as primary prophylaxis (PP) to reduce incidence of febrile neutropenia (FN). However, impact of GCSF duration on FN had not been thoroughly evaluated.
Objectives :
To compare FN incidence and hospitalization outcomes among breast cancer patients who had received no-PP, 4/5-day PP or 7-day PP in docetaxel cycles.
Methodology :
We have identified 3916 breast cancer patients aged ≥18 years from electronic patient records of public hospitals in Hong Kong in 1/1/2014-31/12/2016. Docetaxel and cyclophosphamide (TC); doxorubicin, cyclophosphamide then docetaxel (AC-T); fluorouracil, epirubicin, cyclophosphamide then docetaxel (FEC-T); docetaxel, carboplatin and trastuzumab (TJH); and docetaxel, doxorubicin and cyclophosphamide (TAC) were evaluated. Primary outcome was FN incidence. Secondary outcomes included FN hospitalization rate, length-of-stay and time-to-first hospitalization. Number-needed-to-treat analysis was also used.
Result & Outcome :
A total of 2518 patients were included. PP reduced FN incidence in patients using TC (no-PP 21.69%, 4/5-day PP 7.95%, 7-day PP 5.33%; odd ratio (OR): 4/5-day PP 0.31 (p< .001), 7-day PP 0.20 (p< .001)) and TJH (no-PP 38.26%, 4/5-day PP 8.33%, 7-day PP 8.57%; OR: 4/5-day PP 0.15 (p< .001); 7-day PP 0.15 (p< .001)). FN incidence did not differ among PP regimens. For TC, treating 6 and 7 patients with 7-day and 4/5-day PP could avoid one case of FN. Treating 3 patients with either 7- or 4/5-day PP could prevent a case of FN in TJH. In AC-T and FEC-T, 4/5-day PP had lower FN incidence than prophylaxis-free cases (AC-T: no-PP 20.93%, 4/5-day PP 6.84%; OR 0.28 (p=0.005); FEC-T: no-PP 9.91%, 4/5-day PP 4.77%; OR 0.46 (p=0.035)). Only 8 out of 245 FN cases (3.27%) were not hospitalized. Mean time-to-first hospitalization was 8.21±2.44 days since docetaxel administration. Duration of FN hospitalization did not differ among PP regimens. The result demonstrated PP GCSF for docetaxel could significantly reduce FN incidence. However, 7-day PP could not further reduce FN incidence and alter hospitalization outcomes.
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