Neutropenic complications in Chinese patients with breast cancer in a real-world setting

Purpose: Because little is known about chemotherapy-induced neutropenic complications (CINC) in the Chinese population, this study aimed to investigate the incidence and risk factors of CINC and granulocyte colony stimulating factor (G-CSF) usage in Chinese patients with breast cancer. Methods: This study was a single-center, observational, retrospective cohort. A total of 1490 breast cancer patients who received chemotherapy from Jan 2011 to Dec 2012 were included. Multivariate logistic regression was conducted to identify the independent risk factors of CINC. Results: Without G-CSF primary prophylaxis, the CINC incidence was 46.4% in breast cancer patients. Only 1.9% of the patients received G-CSF as secondary prophylaxis, whereas 100% of the patients received G-CSF as treatment. Among the CINC patients, 29.0% received impaired chemotherapy delivery (dose reduction or delay). Risk factors for CINC were identified, such as age, neutropenia history, previous docetaxel or capecitabine treatment and abnormal baseline lymphocyte and hemoglobin levels. Present chemotherapy regimens containing paclitaxel, docetaxel, anthracycline or gemcitabine were also associated with a significantly higher risk of CINC. Conclusions: The incidence of CINC in Chinese breast cancer patients in a real-world setting was higher than generally reported. However, instead of upfront G-CSF prophylaxis, most G-CSF use in treatment was less evidence-based. The predictive risk factors for CINC was identified to guide appropriate support care and warrant the closer surveillance of patients who are at a high risk of CINC.