title: Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: a systematic review.
abstract: Due to the high rate of febrile neutropenia (FN) with docetaxel-cyclophosphamide (DC) chemotherapy, primary FN prophylaxis is recommended. However, the optimal choice of prophylaxis [i.e., granulocyte-colony stimulating factors (G-CSF) or antibiotics] is unknown. A systematic review was performed to address this knowledge gap.
  
  
  
  Embase, Ovid Medline, Pubmed, the Cochrane database of systematic reviews, and Cochrane register of controlled trials were searched from 1946 to April 2016 for studies evaluating primary prophylactic FN treatments in breast cancer patients receiving DC chemotherapy. Outcome measures evaluated included: incidence of FN and treatment-related hospitalizations, chemotherapy dose reduction/delays/discontinuations, and adverse events. Screening and data collection were performed by two independent reviewers.
  
  
  
  Of 2105 identified records, 7 studies (n = 2535) met the pre-specified eligibility criteria. Seven additional studies (n = 621) were identified from prior systematic reviews. There were 3 randomized controlled trials (RCTs) (n = 2256) and 11 retrospective studies (n = 900). Study sample sizes ranged from 30 to 982 patients (median 99.5), evaluating pegfilgrastim (n = 1274), filgrastim (n = 1758), and oral ciprofloxacin (n = 108). Given the heterogeneity of patients and study design, a narrative synthesis of results was performed. Median FN rates with and without primary prophylaxis were 6.6 % (IQR 3.9-10.6 %) and 31.3 % (IQR 25-33 %), respectively. No FN-related deaths were reported. No RCT directly compared G-CSF with antibiotic interventions.
  
  
  
  Primary FN prophylaxis reduces the incidence of FN. Despite considerable cost and toxicity differences between G-CSF and antibiotics, there is insufficient data to make a recommendation of one strategy over another.
authors: Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada.
authors: Ricardo
authors: R
authors: Fernandes
authors: Ottawa Hospital Research Institute, Ottawa, Canada.
authors: Sasha
authors: S
authors: Mazzarello
authors: Ottawa Hospital Research Institute, Ottawa, Canada.
authors: Carol
authors: C
authors: Stober
authors: Ottawa Hospital Research Institute, Ottawa, Canada.
authors: Lisa
authors: L
authors: Vandermeer
authors: Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.
authors: Shaan
authors: S
authors: Dudani
authors: Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada.
authors: Mohamed F K
authors: MF
authors: Ibrahim
authors: Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.
authors: Habeeb
authors: H
authors: Majeed
authors: Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.
authors: Kirstin
authors: K
authors: Perdrizet
authors: The Ottawa Hospital, Ottawa, Canada.
authors: Risa
authors: R
authors: Shorr
authors: Department of Medicine, Clinical Epidemiology Program, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
authors: Brian
authors: B
authors: Hutton
authors: Department of Medicine, Clinical Epidemiology Program, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
authors: Dean
authors: D
authors: Fergusson
authors: Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada. mclemons@toh.on.ca.|Ottawa Hospital Research Institute, Ottawa, Canada. mclemons@toh.on.ca.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada. mclemons@toh.on.ca.
authors: Mark
authors: M
authors: Clemons
mesh_terms: D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy; D018890:Chemoprevention; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D064147:Febrile Neutropenia / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; D003520:Cyclophosphamide
keywords: Antibiotics; Breast cancer; Docetaxel–cyclophosphamide; Febrile neutropenia; Granulocyte-colony stimulating factors