TITLE:
First Cycle Neutrophil Count and Subsequent Chemotherapy Dose Delivery in Breast Cancer Patients Receiving Adjuvant Chemotherapy
AUTHORS:
Ahmed Ashour, Gamal El-Husseiny, Amr Abdel Aziz, Waleed O. Arafat
KEYWORDS:
Breast Cancer; Chemotherapy; Neutropenia
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.5 No.2,
February
10,
2014
ABSTRACT: Background: Chemotherapy-induced neutropenia is a major dose-limiting
toxicity of systemic cancer chemotherapy, and it is associated with substantial
morbidity, mortality, and costs. The ability to predict the group of patients
who are at high risk for neutropenic complications might help to reduce the
morbidity due to febrile neutropenia and increase the likelihood of delivering
full chemotherapy dose on time. In addition, hematopoietic growth factors could
be administered to patients who need them and allow more efficient use of
medical resources. Methods: The study included 120 female
patients with breast cancer, treated in adjuvant setting with FAC chemotherapy
regimen. Chemotherapy was delayed if the ANC was less than 1500 cells/μL on the
planned first day of the cycle. Dose delays would be for 1 week. The
chemotherapy dose was reduced if the patient experienced an episode of febrile
neutropenia. Dose reductions usually consist of a 20% reduction in
dosage of all chemotherapy drugs. Results: Out of the 120
patients in the study, 58 patients experienced neutropenic complications
(febrile neutropenia or dose delayed) accounting for 48.3% of total sample
size. In univariate analysis, there was statistically significant
association between first cycle ANC nadir and neutropenic complication (p = 0.0001). There was also
statistically significant association between pretreatment first cycle ANC (p = 0.001), pretreatment platelets count
(p = 0.054), first
cycle platelets count nadir (p = 0.041), number of
involved lymph nodes (p = 0.031) and the
occurrence of varies neutropenic complications. However, in multivariate analysis, ANC nadir was only the independent
risk factor for occurrence of neutropenic. Conclusions: The first cycle absolute neutrophil counts nadir provides
useful information on the risk of future neutropenia, febrile neutropenia and
dose delay or reduction with estimated sensitivity and specificity, which were 64.5% and 77.6%, respectively. Other factors such as pretreatment
absolute neutrophil count, number of involved LN, pretreatment platelet count
and first cycle platelet nadir can be used to predict occurrence of neutropenic
complications in breast cancer patients undergoing chemotherapy. Further studies are needed among different populations with different
tumor types and different treatment regimens to confirm the results and explore
other factors which may contribute to occurrence of neutropenic complications.