title: Adjuvant Docetaxel and Cyclophosphamide (DC) with prophylactic granulocyte colony-stimulating factor (G-CSF) on days 8 &12 in breast cancer patients: a retrospective analysis.
abstract: OBJECTIVE
  Four cycles of docetaxel/cyclophosphamide (DC) resulted in superior survival than doxorubicin/cyclophosphamide in the treatment of early breast cancer. The original study reported a 5% incidence of febrile neutropenia (FN) recommending prophylactic antibiotics with no granulocyte colony-stimulating factor (G-CSF) support. The worldwide adoption of this protocol yielded several reports on substantially higher rates of FN events. We explored the use of growth factor (GF) support on days 8 and 12 of the cycle with the original DC protocol.
  
  
  METHODS
  Our study included all consecutive patients with stages I-II breast cancer who were treated with the DC protocol at the Institute of Oncology, Davidoff Center (Rabin Medical Center, Petah Tikva, Israel) from April, 2007 to March, 2012. Patient, tumor characteristics, and toxicity were reported.
  
  
  RESULTS
  In total, 123 patients received the DC regimen. Median age was 60 years, (range, 25-81 years). Thirty-three patients (26.8%) were aged 65 years and older. Most of the women (87%) adhered to the planned G-CSF protocol (days 8 &12). 96% of the patients completed the 4 planned cycles of chemotherapy. Six patients (5%) had dose reductions, 6 (5%) had treatment delays due to non-medical reasons. Thirteen patients (10.6%) experienced at least one event of FN (3 patients had 2 events), all requiring hospitalization. Eight patients (6.5%) required additional support with G-CSF after the first chemotherapy cycle, 7 because of FN and one due to neutropenia and diarrhea.
  
  
  CONCLUSIONS
  Primary prophylactic G-CSF support on days 8 and 12 of the cycle provides a tolerable option to deliver the DC protocol. Our results are in line with other retrospective protocols using longer schedules of GF support.
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Rinat
authors.initials: R
authors.lastname: Yerushalmi
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Hadar
authors.initials: H
authors.lastname: Goldvaser
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Sulkes
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Irit
authors.initials: I
authors.lastname: Ben-Aharon
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hendler
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Victoria
authors.initials: V
authors.lastname: Neiman
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Noa Beatrice
authors.initials: NB
authors.lastname: Ciuraru
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Luisa
authors.initials: L
authors.lastname: Bonilla
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Limor
authors.initials: L
authors.lastname: Amit
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Alona
authors.initials: A
authors.lastname: Zer
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Granot
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Shulamith
authors.initials: S
authors.lastname: Rizel
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Salomon M
authors.initials: SM
authors.lastname: Stemmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage*; D000077143:Docetaxel; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D007557:Israel; D008875:Middle Aged; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; D003520:Cyclophosphamide