Comparison of the incidence of febrile neutropenia in obese and normal weight breast cancer patients receiving myelosuppressive chemotherapy and prophylactic pegfilgrastim

Abstract

Purpose

Common breast cancer chemotherapy regimens are associated with a risk of febrile neutropenia, so prophylactic colony-stimulating factors are incorporated for high-risk patients. Filgrastim utilizes weight-based dosing; however, its sustained-release formulation utilizes fixed dosing. The purpose of this study is to determine whether obese breast cancer patients who receive pegfilgrastim are at increased risk of developing febrile neutropenia.

Methods

This study is a single-center, retrospective chart review. Breast cancer patients were categorized as normal weight (body mass index < 30), overweight (body mass index 30–39), or obese (body mass index ≥ 40).

Results

A total of 442 eligible patients were identified between 1 July 2012 and 19 May 2016. Twenty-eight were included in the obese group. Twenty-eight patients from each non-obese group were randomly selected to make up the overweight and normal weight groups. Incidence of febrile neutropenia was 1, 2, and 2 of 28 in the normal weight, overweight, and obese research groups, respectively. Increased use of antibiotics was observed in the obese group as compared to the normal and overweight groups (2, 1, 1, respectively; p = 0.0005). Median number of days on antibiotics was statistically significantly higher in the obese group at 10 days compared to the normal and overweight groups at seven days (p = 0.03).

Conclusion

Obese patients are not at increased risk of febrile neutropenia. However, they may have a lower threshold for febrile neutropenia and require more antibiotics after chemotherapy. Clinical significance of these results cannot be determined given the small sample size, so further multicenter studies are required.

Keywords

Breast cancer febrile neutropenia obesity pegfilgrastim

Get full access to this article

View all access options for this article.

References

National Cancer Center Network. NCCN clinical practice guidelines in oncology. Myeloid growth factors. Version 1. 2018. https://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.pdf.

Amgen Inc. Neupogen (package insert), Thousand Oaks, CA: Amgen Inc, 2016.

Amgen Inc. Neulasta (package insert), Thousand Oaks, CA: Amgen Inc, 2016.

Yang

Kido

. Pharmacokinetics and pharmacodynamics of pegfilgrastim. Clin Pharmacokinet 2011; 50: 295–309.

Green

Koelbl

Baselga

et al.

A randomized, double-blind, multicenter, phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol 2003; 14: 29–35.

Griggs

Mangu

Anderson

et al.

Appropriate chemotherapy dosing for obese adult patients with cancer: American Cancer Society of Clinical Oncology clinical practice guidelines. J Clin Oncol 2012; 30: 1553–1561.

Masuda

Tokuda

Nakamura

et al.

Dose response of pegfilgrastim in Japanese breast cancer patients receiving six cycles of docetaxel, doxorubicin, and cyclophosphamide therapy: a randomized controlled trial. Support Care Canc 2015; 23: 2891–2898.

Holmes

O’Shaughnessy

Vukelja

et al.

Blinded, randomized multicenter study to evaluate single administration of pegfilgrastim once per cycle versus daily pegfilgrastim as an adjunct to chemotherapy in patients with high-risk stage II or stage III/IV breast cancer. J Clin Oncol 2002; 20: 727–731.