Abstract P3-15-09: Impact of granulocyte colony-stimulating factors on febrile neutropenia risk during early-stage breast cancer treatment
Bibliographic record
Abstract
Abstract Febrile neutropenia (FN) is a significant cause of both mortality and morbidity in patients undergoing adjuvant or neoadjuvant chemotherapy for early-stage breast cancer (ESBC). The risk of FN varies with respect to the type of chemotherapy used and patient-specific characteristics. Granulocyte colony-stimulating factors (G-CSF) are recommended, but not mandatory, as primary prophylaxis for patients at high-risk of FN. This study aimed to evaluate the impact of filgrastim and pegfilgastrim on the incidence of FN during adjuvant and neoadjuvant chemotherapy for ESBC. Risk factors for FN were also assessed. We conducted a retrospective cohort study that included 297 consecutive patients undergoing adjuvant or neoadjuvant chemotherapy for ESBC between May 2010 and May 2012. Patients on clinical trials were excluded. 173 patients (58%) received primary G-CSF prophylaxis whereas 124 (42%) did not. In patients receiving G-CSF prophylaxis, filgrastim was more commonly prescribed (59.9%), due to reimbursement reasons in Quebec. In total, 38 patients (12.8%) manifested at least one episode of FN. The incidence of FN was significantly reduced in patients receiving primary prophylaxis with G-CSF (p = 0.012). The most commonly prescribed chemotherapy protocols were FEC-D (5-Fluorouracil, epirubicin, cyclophosphamide followed by docetaxel), AC-T (Adriamycin, cyclophosphamide followed by paclitaxel), and TC (docetaxel and cyclophosphamide). The use of G-CSF as primary prophylaxis was associated with a decrease in FN incidence in patients receiving FEC-D and TC. Table 1 Incidence of febrile neutropenia in early-stage breast cancer chemotherapy G-CSF primary prophylaxis N = 173Absence of G-CSF prophylaxis N = 124 N (%)N (%) Febrile neutropenia (all chemotherapy)15 (9)23 (19)p = 0.012*TC4/51 (8)5/11 (45)p = 0.01*FEC-D6/59 (10)8/27 (30)p = 0.023*AC-T3/31 (10)8/63 (13)p = 0.668* denotes statistical significance at p < 0.05 One death occurred in a patient receiving FEC-D who had not received prophylaxis. There was no significant difference in the dosing of filgrastim between patients with FN (mean dose received = 5.289 mcg/kg) and those without FN (mean = 5.167mcg/kg) (p = 0.742). Furthermore, previously described risk factors for FN such as age, comorbidities and decreased baseline albumin were not associated with an increased of FN in our study. Although this was a retrospective study with inherent limitations, our cohort included, to our knowledge, the largest number of patients in a study of G-CSF use in ESBC. We found a statistically significant reduction of FN in patients receiving primary G-CSF prophylaxis. Primary prophylaxis should be routinely offered to patients undergoing chemotherapy for ESBC and in particular, to those receiving docetaxel-containing regimens. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-15-09.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".