487P - Real-world feasibility of adjuvant TAC with pegylated G-CSF in resectable breast cancer: A single-center experience

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Early Stage
Supportive Care
Surgery and/or Radiotherapy of Cancer
Presenter Ji Hyun Park
Citation Annals of Oncology (2016) 27 (suppl_9): ix157-ix160. 10.1093/annonc/mdw595
Authors J.H. Park1, B. Kwon2, J. Ahn1, J.E. Kim1, K.H. Jung1, G. Gong3, H.J. Lee3, B. Son4, S. Ahn4, H. Kim5, H.J. Shin5, D. Moon6, S.B. Kim1
  • 1Department Of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 138-736 - Seoul/KR
  • 2Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 138-736 - Seoul/KR
  • 3Department Of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 138-736 - Seoul/KR
  • 4Department Of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 138-736 - Seoul/KR
  • 5Department Of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 138-736 - Seoul/KR
  • 6Department Of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 138-736 - Seoul/KR

Abstract

Background

Although adjuvant TAC is a viable treatment option for operable breast cancer, concern for non-negligible toxicity, particularly of febrile neutropenia, has been consistent. In this study, we aimed to figure out virtual toxicity profiles in patients who received adjuvant TAC with concurrent use of pegylated G-CSF.

Methods

We retrospectively reviewed the medical charts of 127 patients with operable breast cancer who received adjuvant TAC with pegylated G-CSF between July of 2014 and April of 2016 in Asan Medical Center (Seoul). All patients were supported by pegylated G-CSF from the first cycle of chemotherapy.rn

Table: 487P Toxicity profiles

rnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrn
ToxicityTotal (n = 145)
Any grade, N (%)Grade 1/2, N (%)Grade 3, N (%)Grade 4, N (%)
Hematologic
Neutropenia14 (11.0)1 (0.8)4 (3.1)9 (7.1)
Febrile neutropenia7 (5.5)-7 (5.5)-
Cycle 1rnrn4 (57.1)rn
Cycle 2rnrn1 (14.3)rn
Cycle 5rnrn2 (28.6)rn
Infection without neutropenia4 (3.1)3 (2.4)1 (0.8)rn
Anemia15 (11.8)14 (11)-1 (0.8)
Thrombocytopenia1 (0.8)--1 (0.8)
Non-Hematologic
Stomatitis35 (27.6)35 (27.6)-rn
Skin rash13 (10.2)12 (9.5)1 (0.8)rn
Asthenia7 (5.5)7 (5.5)-rn
Generalized edema29 (22.8)29 (22.8)-rn
Myalgia57 (44.9)56 (44.1)1 (0.8)rn
Headache or dizziness13 (10.2)13 (10.2)-rn
Peripheral neuropathy43 (33.9)43 (33.9)-rn
Fever6 (4.7)6 (4.7)-rn
AST/ALT elevation3 (2.4)3 (2.4)rnrn
Weight loss8 (6.3)8 (6.3)-rn
Drug-induced pneumonitis--1 (0.8)rn
Congestive heart failure---rn
Alopecia28 (22.0)5 (4.0)1(0.8)rn
Anorexia19 (15.0)19 (15.0)-rn
Nausea63 (49.6)63 (49.6)-rn
Vomitting11 (8.7)11 (8.7)-rn
Abdominal discomfort*23 (18.1)23 (18.1)-rn
Diarrhea21 (16.5)18 (14.2)3 (2.4)rn
Constipation16 (12.6)16 (12.6)-rn
rn

Results

During the median follow-up period of 8.8 months (range, 8.1-9.4), a total of 746 cycles of adjuvant TAC were administerd to 127 patients, and 5 patients eventually discontinued the treatment because of significant adverse events (n = 2, 1.6%) or refusal (n = 3, 2.4%). Febrile neutropenia was reported in 7 patients (5.5%), which were mostly confined to cycle 1 or 2 (71.4%). Median duration of hospital stay and time for recovery of neutropenia were 2 days. Toxicities were generally grade 1 or 2, of which nausea and myalgia were most frequent (Table). However, among 122 patients completed 6 cycles of adjuvant TAC, dose reduction or delay was found in 36 cases in 33 patients (27.0%); 13 cases:hematologic toxicities, 23 cases:non-hematologic toxicities. Febrile neutropenia (n = 6, 4.8%) and peripheral neuropathy (n = 6, 4.8%) were two most causative toxicities. Relative dose intensities of docetaxel, doxorubicin, and cyclophosphamide were 96%, 97%, and 98%, respectively. There has been no documented relapse or death.

Conclusions

Concurrent use of pegylated G-CSF could significantly reduce the incidence of febrile neutropenia and its fatality. However, a considerable number of dose reduction or delay from non-hematologic toxicities warrants careful selection of patient receiving adjuvant TAC, and further improvement of docetaxel-based regimen is needed.

Clinical trial indentification

not applicable

Legal entity responsible for the study

N/A

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.