title: [Neoadjuvant chemotherapy using epirubicin, cyclophosphamide and fluorouracil: neutropenia and elevation of transaminase, and their management].
abstract: OBJECTIVE
  To retrospectively investigate the incidence of severe neutropenia and elevation of transaminase during neoadjuvant chemotherapy using epirubicin, cyclophosphamide and fluorouracil in breast cancer patients.
  
  
  METHODS
  From January 2011 to December 2012, 303 consecutive breast cancer patients with complete treatment data treated in our department were included in this analysis. All patients received neoadjuvant chemotherapy with equal dose of EPI (100 mg/m(2)) administered every 3 weeks for 4 cycles before surgery.
  
  
  RESULTS
  200 patients (66.0%) experienced at least one episode of grade 3/4 neutropenia/leukopenia, among them 176 patients experienced their first episode after the first cycle. Febrile neutropenia (FN) occurred in 13 patients for 14 episodes. Elevation of transaminase occurred in a total of 46 patients (15.2%), among them, grade 2 or higher elevation occurred in 15 patients (5.0%). Three blood test plans were adopted to monitor the patients during chemotherapy: (1) Routine blood count repeated every week; (2) Routine blood count before and on day 10 of each chemotherapy episode; (3) Routine blood count before and on day 7, 10 and 14 of each chemotherapy episode. The number of patients whose chemotherapy was delayed due to 3/4 neutropenia/leucopenia in each blood test plan was 3 (5.0%), 7 (3.9%) and 2 (3.2%), respectively. The number of patients with febrile neutropenia (FN) in each blood test plan was 2 (3.3%), 8 (4.4%) and 3 (4.8%), respectively. No statistically significant difference in treatment delay or the incidence of FN was observed among different blood test plans. No statistically significant difference in the incidence of grade 3/4 neutropenia/leukopenia or grade 2 or higher transaminase elevation was observed among different 5-Fu regimens.
  
  
  CONCLUSIONS
  During neoadjuvant chemotherapy using FE100 C, Fci E100 C or E100 C for breast cancer patients without routine prophylactic G-CSF, the incidence of grade 3/4 neutropenia/leukopenia is 66.0%. With the patient management plan we adopted, 4.3% of patients developed febrile neutropenia. Prophylactic medication may not be necessary for patients without evident liver dysfunction.
authors.affiliation: Breast Cancer Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital ＆amp; Institute, Beijing 100142, China.
authors.forename: Xinguang
authors.initials: X
authors.lastname: Wang
authors.affiliation: Breast Cancer Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital ＆amp; Institute, Beijing 100142, China.
authors.forename: Tie
authors.initials: T
authors.lastname: Fan
authors.affiliation: Breast Cancer Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital ＆amp; Institute, Beijing 100142, China.
authors.forename: Zhaoqing
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Breast Cancer Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital ＆amp; Institute, Beijing 100142, China.
authors.forename: Tianfeng
authors.initials: T
authors.lastname: Wang
authors.affiliation: Breast Cancer Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital ＆amp; Institute, Beijing 100142, China.
authors.forename: Yuntao
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Breast Cancer Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital ＆amp; Institute, Beijing 100142, China.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Li
authors.affiliation: Breast Cancer Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital ＆amp; Institute, Beijing 100142, China; Email: ouyanghongtao@263.net.
authors.forename: Tao
authors.initials: T
authors.lastname: Ouyang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D015251:Epirubicin / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor; D006801:Humans; D015994:Incidence; D020360:Neoadjuvant Therapy; D009503:Neutropenia / Q000378:metabolism; D012189:Retrospective Studies; D000637:Transaminases / Q000378:metabolism*
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D015251:Epirubicin; D003520:Cyclophosphamide; D000637:Transaminases; D005472:Fluorouracil