Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
Med Oncol. 2012 Sep;29(3):1495-501. doi: 10.1007/s12032-011-0035-5. Epub 2011 Aug 5.
US Oncology Research Trial 9735 reported that TC improved overall survival when compared to doxorubicin and cyclophosphamide in early-stage breast cancer. Despite 61% grades 3-4 neutropenia in the TC arm, only 5% of patients developed febrile neutropenia (FN) without primary prophylactic GCSF (ppGCSF). TC has risen in popularity, particularly in older patients or in those where an anthracycline is contraindicated. Other studies examining the toxicity of TC without ppGCSF reported a higher incidence of FN between 23 and 46%. We reviewed our institutional experience with ppGCSF and the TC regimen. Women treated with adjuvant TC and pegfilgrastim at Roswell Park Cancer Institute were identified from the pharmacy database between 8/2006 and 11/2010. Patient characteristics and comorbidities were abstracted. Endpoints included incidence of FN, hematologic toxicities, relative dose intensity (RDI), and other acute complications. Docetaxel 75 mg/m(2) and cyclophosphamide 600 mg/m(2) were given every 21 day/cycle for a planned four cycles. All patients received pegfilgrastim 6 mg on day 3. One hundred and eleven women with median age of 56 years (27-79) were identified. Twenty-two percent of patients were ≥ 65 at diagnosis. Eight patients developed FN (7%). Ninety-five patients (86%) were able to complete four cycles. Completion rate was significantly lower in patients with age ≥ 65 (71% vs. 90%; P = 0.02). Incidence of hospitalization, delay, RDI <85%, and dose reduction were not significantly different between the age groups. The overall incidence of FN was 7%. Older patients were significantly less likely to complete four cycles of TC as planned. ppGCSF should be strongly considered in breast cancer patients receiving adjuvant TC chemotherapy.
美国肿瘤学研究试验 9735 报告称，与多柔比星和环磷酰胺相比，TC 可改善早期乳腺癌的总生存期。尽管 TC 组有 61%的患者出现 3-4 级中性粒细胞减少症，但只有 5%的患者出现无原发性预防性 G-CSF（ppG-CSF）的发热性中性粒细胞减少症（FN）。TC 的应用越来越广泛，特别是在老年患者或不能使用蒽环类药物的患者中。其他研究报告称，在没有使用 ppG-CSF 的情况下，TC 的毒性发生率在 23%至 46%之间更高。我们回顾了我们机构使用 ppG-CSF 和 TC 方案的经验。从 2006 年 8 月至 2010 年 11 月，从药房数据库中确定了在罗斯韦尔公园癌症研究所接受辅助 TC 和培非格司亭治疗的女性。提取患者特征和合并症。终点包括 FN、血液学毒性、相对剂量强度（RDI）和其他急性并发症的发生率。每 21 天/周期给予多西他赛 75 mg/m2和环磷酰胺 600 mg/m2，计划给予 4 个周期。所有患者在第 3 天接受培非格司亭 6mg。共确定了 111 名中位年龄为 56 岁（27-79 岁）的女性。22%的患者在诊断时年龄≥65 岁。8 名患者发生 FN（7%）。95 名患者（86%）能够完成 4 个周期。≥65 岁患者完成率显著降低（71%比 90%；P=0.02）。年龄组之间的住院率、延迟、RDI<85%和剂量减少无显著差异。FN 的总体发生率为 7%。年龄较大的患者完成计划的 TC 四个周期的可能性明显较低。接受辅助 TC 化疗的乳腺癌患者应强烈考虑使用 ppG-CSF。
