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Acta Oncol. 2019 Oct 4:1-7. doi: 10.1080/0284186X.2019.1670353. [Epub ahead of print]

Neutropenic complications in the PANTHER phase III study of adjuvant tailored dose-dense chemotherapy in early breast cancer.

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Department of Oncology-Pathology, Karolinska Institutet , Stockholm , Sweden.
Breast Cancer, Endocrine Tumours and Sarcoma Section, Theme Cancer, Karolinska University Hospital , Stockholm , Sweden.
CKC, Theme Cancer, Karolinska University Hospital , Stockholm , Sweden.
Department of Surgery, Medical University of Vienna , Vienna , Austria.
Austrian Breast and Colorectal Cancer Study Group , Vienna , Austria.
Department of Medical Oncology, Medical University , Vienna , Austria.
Gaston H. Glock Research Center, Medical University , Vienna , Austria.
IIIrd Medical Department, Cancer Cluster Salzburg, Salzburg Cancer Research Institute, Paracelsus Medical University Salzburg , Salzburg , Austria.
Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch , Berlin , Germany.
Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Academic Hospital of the Goethe University , Frankfurt , Germany.
German Breast Group, Neu-Isenburg , Germany.


Introduction: Myelosuppresion is a common side effect of chemotherapy and granulocyte-colony stimulating factor (G-CSF) is often used to reduce the risk of neutropenic events. The purpose of this exploratory analysis was to investigate neutropenic complications in the phase III PANTHER trial of standard 3-weekly chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide plus docetaxel (FEC/D) versus bi-weekly tailored dose-dense EC/D adjuvant chemotherapy in breast cancer. Patients and methods: Febrile neutropenia, neutropenic infection and infection grade 3-4 according to CTC AE 3.0, were explored in relation to G-CSF use. Per cycle analysis was performed concerning dose reduction and dose delays in conjunction with G-CSF administration. Results: In the experimental group, 98.9% of patients received primary G-CSF support during EC and 97.4% during docetaxel, compared with 49.7% during FEC and 63.88% during docetaxel in the standard group. Overall, the use of G-CSF was associated with a lower risk for developing neutropenic events (OR 0.44, 95% CI 0.35-0.55, p < .001). Chemotherapy delays due to neutropenia and leukopenia were significantly decreased among patients that received G-CSF (OR 0.098, 95% CI 0.06-0.15 and OR 0.32, 95% CI 0.18-0.58, respectively). Discussion: In conclusion, G-CSF support reduces neutropenic events and permits increased relative dose intensity, which is essential for improved survival outcomes.

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