J Breast Cancer.  2016 Mar;19(1):76-82. 10.4048/jbc.2016.19.1.76.

Incidence of Febrile Neutropenia in Korean Female Breast Cancer Patients Receiving Preoperative or Postoperative Doxorubicin/Cyclophosphamide Followed by Docetaxel Chemotherapy

  • 1Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. gmkim77@yuhs.ac
  • 2Department of General Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.


Doxorubicin/cyclophosphamide followed by docetaxel chemotherapy (AC-D) is an intermediate risk factor (incidence of 10%-20%) for febrile neutropenia (FN) in breast cancer. However, the reported incidence of FN while using this regimen was obtained mostly from Western breast cancer patients, with little data available from Asian patients. This study aimed to assess the incidence of FN in Korean breast cancer patients and to describe clinical variables related to FN.
From September 2010 to February 2013, data from the Yonsei Cancer Center registry of breast cancer patients who received neoadjuvant or adjuvant chemotherapy with four cycles of AC-D (60 mg/m2 doxorubicin, 600 mg/m2 cyclophosphamide every 3 weeks for four cycles followed by 75 mg/m2 or 100 mg/m2 docetaxel every 3 weeks for four cycles) were analyzed. The incidence of FN, FN associated complications, dose reduction/delays, and relative dose intensity (RDI) were investigated.
Among the 254 patients reported to the registry, the FN incidence after AC-D chemotherapy was 29.5% (75/254), consisting of 25.2% (64/254) events during AC and 4.7% (12/254) during docetaxel chemotherapy. Dose reductions, delays, and RDI less than 85.0% during AC were observed in 16.5% (42/254), 19.5% (47/254), and 11.0% (28/254) of patients, respectively. Patients with FN events frequently experienced dose reduction/delays, which eventually led to a decreased RDI.
The incidence of FN during AC-D neoadjuvant or adjuvant chemotherapy was higher than expected in Korean breast cancer patients. Whether these patients should be classified as a high-risk group for FN warrants future prospective studies.


Breast neoplasms; Chemotherapy-induced febrile neutropenia; Cyclophosphamide; Docetaxel; Doxorubicin

MeSH Terms

Asian Continental Ancestry Group
Breast Neoplasms*
Chemotherapy, Adjuvant
Chemotherapy-Induced Febrile Neutropenia
Drug Therapy*
Febrile Neutropenia*
Prospective Studies
Risk Factors


  • Figure 1 The consort diagram shows the patient inclusion and exclusion criteria.AC=doxorubicin/cyclophosphamide; D=docetaxel.

  • Figure 2 The treatment schema shows the regimen schedule.IVH=intravenous bolus; IVF=intravenous infusion; CBC=complete blood cell count; SMA=serum metabolic analysis.

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