Do, T., Medhekar, R., Bhat, R., Chen, H., Niravath, P., & Trivedi, M.V. (2015). The risk of febrile neutropenia and need for G-CSF primary prophylaxis with the docetaxel and cyclophosphamide regimen in early-stage breast cancer patients: A meta-analysis. Breast Cancer Research and Treatment, 153, 591–597.

DOI Link

Purpose

STUDY PURPOSE: To determine the rate of febrile neutropenia (FN) with treatment using the docetaxel/cyclophosphamide (TC) regimen, its dependence on patients age, and the efficacy of granulocyte–colony-stimulating factor primary prophylaxis (G-CSFpp) in reducing FN in patients with early-stage breast cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed

KEYWORDS: Docetaxel, cyclophosphamide, febrile neutropenia, breast cancer

INCLUSION CRITERIA: Full-text prospective and retrospective studies published in English reporting the incidence of FN in patients with cancer receiving TC regimen every three weeks with or without G-CSFpp, regardless of independent or comparative investigation for G-CSF

EXCLUSION CRITERIA: Studies reporting duplicated results, studies not reporting the incidence of FN in relationship to G-CSFpp, and studies described only as abstracts or correspondence

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 104

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: PRISMA guidelines; not all studies had all variables of interest (e.g., two studies did not include use of G-CSF; other studies compared the use of G-CSF to not using G-CSF; also, five of the eight studies did not evaluate age).

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 8

TOTAL PATIENTS INCLUDED IN REVIEW = 1,542

KEY SAMPLE CHARACTERISTICS: Patients with early-stage breast cancer who were treated with TC who did or did not receive G-CSFs

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

883 patients across studies did not receive G-CSFs, of which 21.97% developed FN (adjusted rate 23.2%). Compared to patients who did not receive G-CSFs, patients who received G-CSFs had an OR of 0.077 (95% CI [0.013, 0.460]), a 92.3% lower incidence rate. Patients younger than age 65 also had a lower rate of FN (4.2%–66.7%) compared to patients 65 and older (7.7%–88.2%).

Conclusions

Use of G-CSFpp significantly reduces the risk of FN in patients with early-stage breast cancer receiving TC therapy. Patients younger than age 65 also have a reduced risk of FN compared to patients 65 years and older.

Limitations

The reporting of findings differed between use of G-CSF (OR) and no use (%). They did report a 93% lower risk with use of G-CSF. The reporting of age differences did not differentiate between use or no use of G-CSF.

Nursing Implications

Aside from the limitations noted above, use of G-CSF as primary prophylaxis reduces the risk of FN in this patient population. Oncology nurses should be aware of the risks of FN in patients being treated with TC for early-stage breast cancer and promote use of G-CSFpp.

Legacy ID

5797