title: Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors.
abstract: Opportunistic infection with Pneumocystis jiroveci pneumonia (PCP) has not been recognized as a significant complication of early-stage breast cancer treatment. However, we have observed an increase in PCP incidence among patients receiving chemotherapy for early-stage breast cancer. Herein we identify risk factors for and calculate incidence of PCP in this population. We identified all cases of PCP at Dana-Farber Cancer Institute/Brigham and Women's Hospital (DFCI/BWH) from 1/1/2000 to 12/31/2013 in patients with stage I-III breast cancer treated with an adriamycin/cyclophosphamide (AC)-containing regimen. Nineteen cases of PCP in non-metastatic breast cancer patients were identified. All patients with PCP were diagnosed after receipt of either three or four cycles of AC chemotherapy on a dose-dense schedule. Patients who developed PCP were treated with median 16.4 mg prednisone equivalents/day as nausea prophylaxis for a median 64 days. The overall incidence of PCP among 2057 patients treated with neoadjuvant or adjuvant dose-dense AC for three or more cycles was 0.6 % (95 % confidence interval 0.3-1.0 %). No PCP was diagnosed in 1001 patients treated with non-dose-dense AC. There was one death from PCP. Women receiving dose-dense AC chemotherapy for early-stage breast cancer are at risk for PCP. Administering the same chemotherapy and corticosteroid dose over an 8-week versus 12-week non-dose-dense schedule appears to have created a novel infectious vulnerability. Replacing dexamethasone with alternative anti-emetics may mitigate this risk.
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.|Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Adrienne G
authors.initials: AG
authors.lastname: Waks
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.|Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Tolaney
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Galar
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Amal
authors.initials: A
authors.lastname: Arnaout
authors.affiliation: Stanford Health Care, Stanford, CA, USA.
authors.forename: Julie B
authors.initials: JB
authors.lastname: Porter
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.|Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Marty
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.|Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.|Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Hammond
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA. lbaden@bwh.harvard.edu.|Brigham and Women's Hospital, Boston, MA, USA. lbaden@bwh.harvard.edu.|Harvard Medical School, Boston, MA, USA. lbaden@bwh.harvard.edu.|Brigham and Women's Hospital, 75 Francis Street, PBB-A4, Boston, MA, 02115, USA. lbaden@bwh.harvard.edu.
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Baden
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009894:Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D018943:Anthracyclines
keywords: Adjuvant chemotherapy; Breast cancer; Corticosteroids; Pneumocystis jiroveci