title: Incidence of febrile neutropenia in early stage breast cancer patients receiving adjuvant FEC-D treatment.
abstract: OBJECTIVE
  The purpose of this study is to determine the incidence of febrile neutropenia (FN) among women receiving FEC-D (flurouracil 500 mg/m(2), epirubicin 100 mg/m(2), and cyclophosphamide 500 mg/m(2) every 3 weeks for three cycles followed by docetaxel 100 mg/m(2) every 3 weeks for three cycles) chemotherapy for early stage breast cancer (ESBC) and the impact of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis in a non-clinical trial setting.
  
  
  METHODS
  A retrospective chart review of women referred for ESBC to The Moncton Hospital between 2005 and 2010 evaluated patient and disease characteristics, adjuvant chemotherapy receipt, G-CSF usage, FN incidence, hospital admission rates, and length of stay. Association of variables with FN was examined, and exploratory multivariable logistic regression modeling examined the impact of baseline variables on risk of FN.
  
  
  RESULTS
  Of 520 patients enrolled in the database, 251 (48.3 %) received adjuvant chemotherapy for ESBC. Most (66.9 %) received FEC-D. Overall, 55 (21.9 %) patients developed FN. Forty-four (26.2 %) patients on FEC-D developed FN. Forty of 129 (31.0 %) FEC-D patients who did not receive primary G-CSF prophylaxis developed FN, versus 4 of 39 (10.3 %) receiving G-CSF. Receipt of FEC-D or TC (docetaxel 75 mg/m(2) and cyclophosphamide 600 mg/m(2) every 3 weeks for four or six cycles) was associated with odds ratios of 6.5 or 6.77, respectively, for the development of FN. Receipt of trastuzumab with chemotherapy was associated with an odds ratio of 3.48 for developing FN versus no trastuzumab. Primary G-CSF prophylaxis led to a 63 % reduction in the odds ratio of developing FN.
  
  
  CONCLUSIONS
  Incidence of FN with FEC-D treatment is considerably higher in clinical practice than reported in phase III trials. Consistent with ASCO guidelines, prophylactic G-CSF should be considered for all ESBC patients receiving adjuvant FEC-D.
authors.affiliation: Division of Medical Oncology, The Moncton Hospital, 135 MacBeath Ave., Moncton, New Brunswick, E1C 6Z8, Canada, hazemassi@gmail.com.
authors.forename: Hazem
authors.initials: H
authors.lastname: Assi
authors.forename: Joshua
authors.initials: J
authors.lastname: Murray
authors.forename: Laura
authors.initials: L
authors.lastname: Boyle
authors.forename: Daniel
authors.initials: D
authors.lastname: Rayson
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000008:administration & dosage; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D002170:Canada / Q000453:epidemiology; D018890:Chemoprevention / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D003520:Cyclophosphamide / Q000008:administration & dosage*; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D043823:Taxoids / Q000008:administration & dosage*
chemical_list: D000277:Adjuvants, Pharmaceutic; D000970:Antineoplastic Agents; D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil