Systematic review and meta-analysis of febrile neutropenia risk with TCH(P) in HER2-positive breast cancer.

Abstract

BACKGROUND:

Docetaxel, carboplatin and trastuzumab, with or without pertuzumab (TCH(P)), has become the preferred (neo)adjuvant regimen for HER2-positive breast cancer. However, its associated febrile neutropenia (FN) risk is unclear: pivotal studies reported FN risks < 10%, but in clinical practice, a high FN rate (> 20%) was observed. This systematic review and meta-analysis determine the FN risk associated with TCH(P) and the indication for primary prophylactic granulocyte colony-stimulating factor (PP G-CSF).

METHODS:

The MEDLINE, Embase, Web of Science and Cochrane databases were searched for full-text English articles reporting the FN incidence in early breast cancer patients receiving (neo)adjuvant TCH(P). The primary endpoint was the pooled crude FN incidence in patients treated without PP G-CSF using the random effects method. Secondary endpoints were the FN risk with PP G-CSF support, age-related differences in FN and differences in risk with TCH versus TCHP.

RESULTS:

Seventeen studies were included in the systematic review. The pooled estimates of FN incidences were 27.6% (95% CI 18.6 to 37.1) in patients who did not receive PP G-CSF (primary meta-analysis, 9 studies, n = 889) versus 5.0% (95% CI 2.6 to 8.0) in patients administered PP G-CSF (secondary meta-analysis, 7 studies, n = 445). Two studies reported non-significant age-related differences in FN. The risk comparison between TCH and TCHP was inconclusive.

CONCLUSIONS:

The crude FN risk associated with (neo)adjuvant TCH(P) is over 20%, the upper limit above which the international guidelines unanimously advise PP G-CSF administration. G-CSF prophylaxis effectively reduces FN risk and should become the standard of care with (neo)adjuvant TCH(P).

• Authors: Hannah Van Belle, Sara A Hurvitz, Peter J Gilbar, Hans Wildiers
• Journal: Breast cancer research and treatment (Breast Cancer Res Treat) Vol. 190 Issue 3 Pg. 357-372 (Dec 2021) ISSN: 1573-7217 [Electronic] Netherlands
• PMID: 34533681 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Granulocyte Colony-Stimulating Factor
• Docetaxel

Topics

• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Breast Neoplasms (drug therapy, epidemiology)
• Docetaxel (therapeutic use)
• Febrile Neutropenia (chemically induced, epidemiology)
• Female
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Humans