Ann Surg Treat Res.  2018 May;94(5):223-228. 10.4174/astr.2018.94.5.223.

Pegfilgrastim for primary prophylaxis of febrile neutropenia in breast cancer patients undergoing TAC chemotherapy

• Lee J
• Lee JE
• Kim Z
• Han SW
• Hur SM
• Kim SY
• Lee MH
• Lim CW

• KMID: 2410264
• DOI: http://doi.org/10.4174/astr.2018.94.5.223

Abstract

PURPOSE
Primary prophylaxis with granulocyte colony-stimulating factor can effectively prevent febrile neutropenia (FN) during breast cancer treatment. The aims of this study were to evaluate the incidence of FN and the ANC profile in patients undergoing chemotherapy and pegfilgrastim primary prophylaxis.
METHODS
Patients receiving 6 cycles of adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) chemotherapy were included in this study. Pegfilgrastim was administered with analgesics 24 hours after treatment. Laboratory tests were performed on day 0 (before chemotherapy) and ANC was measured daily starting day 5 until it were restored to 1,000/mm3. Bone pain was checked via the numeral rating scale (NRS).
RESULTS
A total of 61 patients and 366 cycles were evaluated. Mean age was 49.2 ± 7.1 years. FN was seen in 5 patients (16.4%) and 12 cycles (3.3%) with pegfilgrastim. Grades 3 and 4 neutropenia was seen in 91.5% of cycles with FN. The ANC nadir was most commonly seen at day 7 and the mean ANC nadir depth was 265.7/m3. Age was negatively correlated with nadir depth (r = −0.137, P = 0.009). Severe pain higher than NRS 7 occurred in less than 20% of patients after the administration of pegfilgrastim.
CONCLUSION
Incidence of FN was low during the chemotherapy by primary prophylaxis with pegfilgrastim. The ANC nadir was seen on day 7 after chemotherapy. Bone pain with pegfilgrastim was well tolerated during TAC chemotherapy.

Keyword

Breast neoplasms; Adjuvant chemotherapy; Febrile neutropenia; Granulocyte colony-stimulating factor

MeSH Terms

Analgesics
Breast Neoplasms*
Breast*
Chemotherapy, Adjuvant
Cyclophosphamide
Doxorubicin
Drug Therapy*
Febrile Neutropenia*
Granulocyte Colony-Stimulating Factor
Humans
Incidence
Neutropenia
Analgesics
Cyclophosphamide
Doxorubicin
Granulocyte Colony-Stimulating Factor

Figure

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  Fig. 1 ANC profiles after chemotherapy. (A) ANC shows lowest value at day 7 after chemotherapy. Panel B shows nadir depth of all cycles regardless of time after chemotherapy.

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  Fig. 2 Severe bone pain related to pegfilgrastim administration. Day 1 represents the day of chemotherapy. Severe pain more than numeral rating scale (NRS) 7 was shown less than 20% during days 3 to 5 after pegfilgrastim administration (day 2).

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