Do Tran, Medhekar Rohan, Bhat Raksha, Chen Hua, Niravath Polly, Trivedi Meghana V
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 1441 Moursund St., Houston, TX, 77030, USA.
Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
Breast Cancer Res Treat. 2015 Oct;153(3):591-7. doi: 10.1007/s10549-015-3531-z. Epub 2015 Sep 4.
The febrile neutropenia (FN) rates reported with the docetaxel 75 mg/m(2) plus cyclophosphamide 600 mg/m(2) (TC) regimen given every 3 weeks vary from 4 to 69 % in early-stage breast cancer (ESBC) patients. This creates uncertainty as to whether patients receiving the TC regimen should also receive granulocyte colony-stimulating factor primary prophylaxis (G-CSFpp), which is recommended when chemotherapy regimens have ≥20 % FN rate. We conducted a meta-analysis of published studies to determine FN rate with the TC regimen, its dependence on patients' age, and the efficacy of G-CSFpp in reducing it in ESBC patients. We systematically searched the literature via PUBMED using the following terms: 'docetaxel', 'cyclophosphamide', 'febrile neutropenia', and 'breast cancer'. Inclusion criteria were full text peer-reviewed clinical studies in English reporting FN rates with TC regimen in relationship to G-CSFpp. Comprehensive meta-analysis software was used for all statistical analyses. Eight studies (N = 1542 patients) were included in our meta-analysis. The pooled mean FN rate was 23.2 % (95 % confidence interval (CI) 6.9-55.2 %; Q = 218.17, I (2) = 97.7). The FN risk in <65 years old patients was lower by 67.7 % compared to that in patients ≥65 years old (pooled odds ratio (OR) 0.323; 95 % CI 0.127-0.820; P = 0.017). The FN risk was reduced by 92.3 % with G-CSFpp (pooled OR 0.077; 95 % CI 0.013-0.460; P = 0.005). Our meta-analysis demonstrated that TC regimen was associated with ≥20 % FN risk, which was significantly higher in patients ≥65 years old and improved with G-CSFpp. G-CSFpp should be considered for all ESBC patients receiving TC regimen, especially those ≥65 years old.
对于每3周给予一次多西他赛75mg/m²加环磷酰胺600mg/m²（TC）方案的早期乳腺癌（ESBC）患者，报告的发热性中性粒细胞减少（FN）发生率在4%至69%之间。这就产生了不确定性，即接受TC方案的患者是否也应接受粒细胞集落刺激因子一级预防（G-CSFpp），而当化疗方案的FN发生率≥20%时推荐使用G-CSFpp。我们对已发表的研究进行了荟萃分析，以确定TC方案的FN发生率、其对患者年龄的依赖性以及G-CSFpp在降低ESBC患者FN发生率方面的疗效。我们通过PUBMED使用以下术语系统地检索了文献：“多西他赛”、“环磷酰胺”、“发热性中性粒细胞减少”和“乳腺癌”。纳入标准为英文全文经同行评审的临床研究，报告TC方案与G-CSFpp相关的FN发生率。所有统计分析均使用综合荟萃分析软件。我们的荟萃分析纳入了8项研究（N = 1542例患者）。汇总的平均FN发生率为23.2%（95%置信区间（CI）6.9 - 55.2%；Q = 218.17，I² = 97.7）。与≥65岁的患者相比，<65岁患者的FN风险低67.7%（汇总比值比（OR）0.323；95% CI 0.127 - 0.820；P = 0.017）。使用G-CSFpp可使FN风险降低92.3%（汇总OR 0.077；95% CI 0.013 - 0.460；P = 0.005）。我们的荟萃分析表明，TC方案的FN风险≥20%，在≥65岁的患者中显著更高，而G-CSFpp可改善这一情况。对于所有接受TC方案的ESBC患者，尤其是≥65岁的患者，应考虑使用G-CSFpp。
