title: Real-world adjuvant TAC or FEC-D for HER2-negative node-positive breast cancer in women less than 50 years of age.
abstract: OBJECTIVE
  We compared the efficacy, toxicity, and use of granulocyte colony-stimulating factor (g-csf) with tac (docetaxel-doxorubicin-cyclophosphamide) and fec-d (5-fluorouracil-epirubicin-cyclophosphamide followed by docetaxel) in women less than 50 years of age.
  
  
  METHODS
  The study included all women more than 18 years but less than 50 years of age with her2-negative, node-positive, stage ii or iii breast cancer diagnosed in Alberta between 2008 and 2012 who received tac (n = 198) or fec-d (n = 274).
  
  
  RESULTS
  The patient groups were well-balanced, except that radiotherapy use was higher in the tac group (91.9% vs. 79.9%, p < 0.001). At a median follow-up of 49.6 months, disease-free survival was 91.4% for tac and 92.0% for fec-d (p = 0.76). Overall survival (os) was 96% with tac and 95.3% with fec-d (p = 0.86).The incidences of grades 3 and 4 toxicities were similar in the two groups (all p > 0.05). Overall, febrile neutropenia (fn) was reported in 11.6% of tac patients and 15.7% of fec-d patients (p = 0.26). However, use of g-csf was higher in the tac group than in the fec-d group (96.4% vs. 71.5%, p < 0.001). Hospitalization for fn was required in 10.5% of tac patients and 13.0% of fec-d patients (p = 0.41). In g-csf-supported and -unsupported patients receiving tac, fn occurred at rates of 11.1% and 33.3% respectively (p = 0.08); in patients receiving the fec portion of fec-d, those proportions were 2.9% and 8.1% respectively (p = 0.24); and in patients receiving docetaxel after fec, the proportions were 4.1% and 17.6% respectively (p < 0.001).
  
  
  CONCLUSIONS
  In women less than 50 years of age receiving adjuvant tac or fec-d, we observed no differences in efficacy or other nonhematologic toxicities. Based on the timing and rates of fn, use of prophylactic g-csf should be routine for the docetaxel-containing portion of treatment; however, prophylactic g-csf could potentially be avoided during the fec portion of fec-d treatment.
authors.affiliation: Department of Oncology, University of Calgary, Calgary, AB;
authors.forename: S
authors.initials: S
authors.lastname: Lupichuk
authors.affiliation: CancerControl Alberta, Alberta Health Services, Calgary, AB;
authors.forename: D
authors.initials: D
authors.lastname: Tilley
authors.affiliation: Department of Oncology, University of Calgary, Calgary, AB;; CancerControl Alberta, Alberta Health Services, Calgary, AB;
authors.forename: X
authors.initials: X
authors.lastname: Kostaras
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, AB.
authors.forename: A A
authors.initials: AA
authors.lastname: Joy
keywords: Efficacy; febrile neutropenia; g-csf; granulocyte colony–stimulating factor; hospitalization; systemic therapy; toxicity