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ERIC J. IP, PHARM.D., BCPS, CSCS, is Assistant Professor, Department of Clinical Sciences, Touro University College of Pharmacy, Vallejo, CA, and Diabetes Specialist and Clinical Pharmacist, Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, CA; at the time of writing, he was Pharmacy Practice Resident, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA. ANNETTE LEE-MA, B.S.PHARM., BCOP, is Oncology Pharmacy Supervisor, Oncology Pharmacy Department; and LAWRENCE S. TROXELL, PHARM.D., is Clinical Operations Manager, Ambulatory Care Clinical Pharmacy, Kaiser Permanente Santa Clara Medical Center. JAMES CHAN, PHARM.D., PH.D., is Pharmacy Quality and Outcomes Coordinator, Pharmacy Outcomes Research Group, Kaiser Permanente, Oakland, CA.

Address correspondence to Dr. Ip at the Touro University College of Pharmacy, 1310 Johnson Lane, Mare Island, Vallejo, CA 94592 (eric.ip{at}touro.edu).

Purpose. The objective of this study was to compare low-dose filgrastim (150 µg/day subcutaneously) with standard-dose subcutaneous filgrastim (300 µg/day) or lenograstim (263 µg/day) in preventing febrile neutropenia and hospitalizations in breast cancer patients receiving the docetaxel–doxorubicin–cyclophosphamide regimen. Methods. A single-center retrospective data analysis was performed involving 22 adult women with breast cancer who concurrently received the docetaxel–doxorubicin–cyclophosphamide chemotherapy regimen and low-dose filgrastim from March 2004 to February 2007. Data from this study were compared to previously published data in which patients received standard-dose filgrastim or lenograstim. Results. More patients developed febrile neutropenia in the low-dose filgrastim group compared with the standard-dose group (32% versus 7.5%, respectively; p = 0.0014; relative risk [RR] = 4.24; 95% confidence interval [CI], 2.04–7.83). More patients were hospitalized due to febrile neutropenia in the low-dose filgrastim group compared with the standard-dose group (32% versus 6.5%, respectively; p < 0.001; RR = 4.89; 95% CI, 2.32–9.13). More chemotherapy cycles resulted in febrile neutropenia in the low-dose filgrastim group compared with the standard-dose group (6.7% versus 1.2%, respectively; p < 0.001; RR = 5.58; 95% CI, 2.49–12.27). Conclusion. In patients with breast cancer treated with the docetaxel–doxorubicin–cyclophosphamide regimen, low-dose filgrastim was associated with a higher frequency of febrile neutropenia, hospitalization due to febrile neutropenia, and cycles with febrile neutropenia compared with a historical control group treated with standard-dose filgrastim or lenograstim. Index terms: Antineoplastic agents; Breast neoplasms; Cyclophosphamide; Docetaxel; Dosage; Doxorubicin; Drug comparisons; Filgrastim; Hematopoietic agents; Lenograstim; Neutropenia; Toxicity

 

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