Risk of Treatment Related Death and Febrile Neutropaenia with Taxane-Based Adjuvant Chemotherapy for Breast Cancer in a Middle Income Country Outside a Clinical Trial Setting

Background: The risk of treatment-related death (TRD) and febrile neutropaenia (FN) with adjuvant taxanebasedchemotherapy for early breast cancer is unknown in Malaysia despite its widespread usage in recent years.This study aims to determine these rates in patients treated in University Malaya Medical Centre (UMMC).Patients and
Methods: Patients who were treated with adjuvant taxane-based chemotherapy for early breastcancer stages I, II or III from 2007-2011 in UMMC were identified from our UMMC Breast Cancer Registry.The TRD and FN rates were then determined retrospectively from medical records. TRD was defined as deathoccurring during or within 30 days of completing chemotherapy as a consequence of the chemotherapy treatment.FN was defined as an oral temperature >38.5°C or two consecutive readings of >38.0°C for 2 hours and anabsolute neutrophil count <0.5x109/L, or expected to fall below 0.5x109/L.
Results: A total of 622 patients receivedadjuvant chemotherapy during this period. Of these patients 209 (33.6%) received taxane-based chemotherapy. 4taxane-based regimens were used namely the FEC-D, TC, TAC and AC-PCX regimens. The commonest regimenemployed was the FEC-D regimen accounting for 79.9% of the patients. The FN rate was 10% and there wasno TRD.
Conclusion: Adjuvant taxane-based chemotherapy in UMMC for early breast cancer has a FN rate of10%. Primary prophylactic G-CSF should be considered for patients with any additional risk factor for FN.