Variation in the use of granulocyte-colony stimulating factor for dose dense paclitaxel: A single institution retrospective study. (December 2016)

• Record Type: Journal Article
• Authors: Barroso-Sousa, Romualdo; Paes, Flavia Rocha; Vaz-Luis, Ines; Batista, Rafael Borges; Costa, Rafael Brant; Losk, Katya; Camuso, Kristen; Metzger-Filho, Otto; Hughes, Melissa E.; Bunnell, Craig A.; Golshan, Mehra; Winer, Eric P.; Lin, Nancy U.
• Is Part Of: Breast. Volume 30(2016)
• Page Start: 136
• Page End: 140
• Publication Date: 2016-12
• Subjects: Dose-dense chemotherapy -- Paclitaxel -- Colony stimulating factors; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2016.09.013
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Introduction: The necessity of using granulocyte-colony stimulating factor (G-CSF) during dose-dense (DD) paclitaxel (T) after doxorubicin and cyclophosphamide (AC) is unclear. Methods: This was a retrospective cohort study including patients with stage I-III breast cancer treated at Dana-Farber Cancer Institute with adjuvant DD-ACT between January 2011 and December 2013. Descriptive analyses evaluating patterns of G-CSF utilization during T were performed. Results: Overall, 156 patients were treated with DD-ACT by 26 providers. The majority of patients (135, 87%) received at least one dose of G-CSF during T (group 1), 17% of these patients received it in only one cycle and 48% received it in all four cycles. Reasons for omitting G-CSF included high baseline absolute neutrophil count and pain. Twenty-one (13%) patients did not receive any G-CSF during T (group 2). Respectively, 94% and 90% of patients completed the treatment in groups 1 and 2. There were no cases of treatment cessation due to neutropenia. Six percent of patients in group 1 had at least one treatment delay. There were no treatment delays reported in group 2. Variation in the use of G-CSF by provider and by patient was found, with 11 providers choosing not to use G-CSF in at least one patient. Conclusions: We identified substantial variation in the use of G-CSF within the practice. However, omission of G-CSF was not associated with treatment delays or adverse events. Prospective studies are warranted to formally test whether routine G-CSF is necessary during dose-dense T therapy. Highlights: There is a substantial variation in the use of prophylactic G-CSF during dose-dense paclitaxel in clinical practice. Reasons for omitting prophylactic G-CSF during DD-T included high baseline absolute neutrophil count and pain. The omission of prophylactic G-CSF during dose-dense paclitaxel was not associated with treatment delay or adverse events.