Incidence of febrile neutropenia during adjuvant chemotherapy for breast cancer: a prospective study

We read with great interest the recent article by Madernas et al . describing the clinical experience of four regional cancer centres in Ontario with rates of febrile neutropenia (FN) stemming from adjuvant FEC-D (5-fluorouracil–epirubicin–cyclophosphamide, then docetaxel) for early-stage breast cancer 1 . Those authors retrospectively reviewed the electronic and paper records of 671 patients treated at the Ottawa Hospital Cancer Centre, the Cancer Centre of Eastern Ontario, the London Regional Cancer Program, and the Northeastern Ontario Regional Cancer Centre, who had completed adjuvant FEC-D chemotherapy between June 1, 2006, and December 31, 2008. They observed an overall fn event rate of 22.7% (152 in 671), which is considerably higher than that reported in the pivotal PACS 01 trial (11.2%) that led to the widespread adoption of adjuvant FEC-D for node-positive early-stage disease 2 . Similar observations have been reported for TC (docetaxel–cyclophosphamide) chemotherapy, another recently introduced adjuvant regimen for early-stage breast cancer 3–5 . Clinical practice guidelines from the American Society of Clinical Oncology and the European Society for Medical Oncology both recommend that primary prophylaxis with granulocyte colony– stimulating factors (G-CSF) be considered for treatment regimens with the probability of a fn event rate of 20% or higher 6,7 . With clinical experience suggesting that fn rates during FEC-D treatment are more common than reported in PACS 01, 35% of patients in the study by Madernas et al . did receive primary prophylaxis with G-CSF, leading to a statistically significant reduction in the observed fn rates for those who received primary prophylaxis compared with those who did not (6.4% vs. 31.4%; relative risk: 0.20; p < 0.001).