Toxicity of docetaxel plus cyclophosphamide as adjuvant therapy for breast cancer in Chinese patients - the Hong Kong experience

• Published in: Asia-Pacific journal of clinical oncology 2009-06, Vol.5 (2), p.123-128
• Main Authors: YAU, Tsz-Kok, NG, Ting-Ying, SOONG, Inda Sung, CHOI, Chi-Wai, LAM, Ka-On, NG, Alice Wan-Ying, LEE, Anne Wing-Mui, TUNG, Yuk
• Format: Article
• Language: English
• Subjects: breast cancer; chemotherapy; Chinese; docetaxel; Hong Kong
• ISSN: 1743-7555; 1743-7563
• DOI: 10.1111/j.1743-7563.2009.01204.x

Aims:  The docetaxel and cyclophosphamide (TC) regimen is increasingly popular as adjuvant chemotherapy for operable breast cancers. We conducted a retrospective study in Hong Kong to evaluate the toxicity of this regimen in Chinese patients. Methods:  Between January 2007 and May 2008 76 female Chinese patients with resected stage I–III operated invasive breast cancer were treated with 4 cycles of TC (75 and 600 mg/m2, respectively, administered i.v. every 3 weeks for four cycles) in two public regional cancer centers of Hong Kong. A total of 24 (32%) patients also received primary prophylactic ciprofloxacin (500 mg twice daily, day 5–14). Chemotherapy‐related toxicities were graded by the CTCAE version 3.0. Results:  The median age was 50 (range 26–67). A total of 68 (89%) patients successfully completed four cycles of chemotherapy. 72 (95%) and 16 (21%) patients developed grade 3–4 neutropenia and febrile neutropenia (FN) infection, respectively, in one or more cycles. However, no grade 3–4 anemia or thrombocytopenia events were observed. Other grade 3–4 non‐hematological toxicities were also uncommon, apart from allergic reactions in two (3%) patients. No viral reactivation was observed among the 8 hepatitis B carriers. Patients with prophylactic ciprofloxacin had less grade 3–4 FN infection (13% vs 25%, P = 0.214) and a higher chance of receiving the full scheduled dose (88% vs 62%, P = 0.045) than patients without. Conclusion:  The myelotoxicity of TC was substantially higher in Chinese patients compared with non‐Chinese patients in developed countries. Routine prophylactic measures are recommended to maintain the dose levels and reduce the risk of FN.