Among node-negative breast cancer patients receiving chemotherapy with TAC (docetaxel, doxorubicin, cyclophosphamide), use of granulocyte-colony stimulating factors (G-CSF) significantly reduced the risk of febrile neutropenia. These results were published in the Annals of Oncology.
Although chemotherapy improves outcomes for many patients with breast cancer, it is associated with unpleasant and sometimes life-threatening side effects. Chemotherapy destroys not only cancer cells, but also normal cells that grow rapidly. These include blood cells forming in the bone marrow, cells in the hair follicles, or cells in the mouth and intestines.
Neutropenia, one of the most common side effects of chemotherapy, occurs when white blood cells (immune cells) are destroyed by chemotherapy, leaving the immune system unable to fight infections. Chemotherapy-induced neutropenia can become a serious condition for several reasons: many patients who develop neutropenia will require a delay in treatment or a dose reduction, which can prevent them from receiving full benefits of treatment; patients who develop neutropenia may require hospitalization; and even minor infections can become life-threatening.
Prophylactic (preventive) treatment with antibiotics or G-CSF has been shown to reduce the probability of developing febrile neutropenia (neutropenia accompanied by fever). G-CSF stimulates the growth of neutrophils, a type of white blood cell that fights infections.
The benefits of prophylactic treatment with G-CSF are likely to be most apparent for chemotherapy regimens that carry a high risk of febrile neutropenia. In women with early-stage, node-positive breast cancer, chemotherapy with TAC (docetaxel, doxorubicin, cyclophosphamide) results in better survival than chemotherapy with FAC (5-fluorouracil, doxorubicin, cyclophosphamide), but also results in higher rates of febrile neutropenia.
To explore the effects of adding prophylactic G-CSF to TAC chemotherapy, an international group of researchers evaluated information from a phase III clinical trial comparing TAC to FAC in high-risk, node-negative breast cancer patients. Some of the patients treated with TAC received prophylactic G-CSF and some did not.
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- Febrile neutropenia occurred in 24.6% of patients who received TAC without prophylactic G-CSF and 6.5% of patients who received TAC with prophylactic G-CSF. Febrile neutropenia occurred in 2.3% of patients treated with FAC.
- All patients experienced a decline in quality of life during chemotherapy; this decline was more apparent for patients treated with TAC than patients treated with FAC. Quality of life improved after completion of chemotherapy.
- Prophylactic G-CSF moderately improved health-related quality of life in patients treated with TAC.
The researchers conclude that these results “support the routine use of [G-CSF] in all breast cancer patients treated with adjuvant TAC chemotherapy.”
 Martin M, Pienkowski T, Mackey J, et al. Adjuvant docetaxel for node-positive breast cancer. New England
Journal of Medicine. 2005;352:2302-2313.
 Martin M, Lluch A, Sequi MA et al. Toxicity and Health-related Quality of Life in Breast Cancer Patients Receiving Adjuvant Docetaxel, Doxorubicin, Cyclophosphamide (TAC) or 5-fluorouracil, Doxorubicin and Cyclophosphamide (FAC): Impact of Ading Primary Prophylactic Granulocyte-colony Stimulating Factor to the TAC Regimen. Annals of Oncology. 2006;17:1205-1212.
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