Aims:
We sought to understand the rate of severe neutropenia, FN, and G-CSF use during TC chemotherapy in routine clinical practice.
Methods:
Retrospective data provided in aggregate form by BioGrid Australia across two Victorian tertiary hospitals from 1 January 2008 – 30 June 2011 were analysed.
Seventy-two ESBC patients receiving TC chemotherapy were identified. Seventy-nine per cent (57/72) of patients received 4 cycles of TC, 14% (10/72) 3 cycles, 4% 2 cycles (3/72) 3% 1 cycle (2/72).
The primary objective was to describe the incidence of FN.
Results:
G-CSF (on all occasions as pegfilgrastim) was used in 47/72 (65%) of patients. Of these 47 over one third (17/47) received pegfilgrastim as primary prophylaxis across all 4 cycles, 30% for 3 cycles, 21% for 2 cycles and 13% for 1 cycle. Of the 19% per cent of patients (14/72) who did experience an episode of FN, half (7/14) occurred in cycle 1, 36% in cycle 2 and 14% in cycle 4 and all such patients received secondary prophylaxis with pegfilgrastim until completion of chemotherapy. Only 1 patient on pegfilgrastim had an episode of FN. Of the 33 patients who received pegfilgrastim who did not experience an FN event, a substantive majority, 79% (26/33) had documented Grade 4 neutropenia, 1% Gr 3, 12% Gr 2 and 58% Gr 1, 27% with grade unknown
Conclusions:
Consistent with other retrospective series using TC, the incidence of severe neutropenia and FN found in this investigation of routine clinical practice, was higher than in the reported randomised study. At least nineteen per cent of patients experienced FN, most commonly in cycle 1. Vigilance regarding neutropenia and intervention with G-CSF where appropriate may well reduce the risk of FN.”