隔日非格司亭支持乳腺癌剂量密集型新辅助化疗的可行性分析

Feasibility of short-term filgrastim in supporting dose-dense neoadjuvant chemotherapy for primary breast cancer

目的检验隔日非格司亭(Filgrastim)即短疗程短效粒细胞集落刺激因子(rhGCSF)支持乳腺癌剂量密集型新辅助化疗的有效性与安全性。方法收集2015年7月至2018年6月于北京大学肿瘤医院乳腺癌预防治疗中心接受剂量密集型新辅助化疗同时使用隔日非格司亭预防性支持的原发性乳腺癌患者的病例信息。所有患者均计划接受4周期剂量密集型表阿霉素100 mg/m^(2)+环磷酰胺600 mg/m^(2)术前新辅助化疗,同时于化疗周期第4、6、8、10天皮下注射非格司亭200~300μg。收集化疗延迟、药物减量情况计算相对剂量强度(RDI),同时记录FN发生情况。结果共301例乳腺癌患者信息纳入后续分析,其中15例发生化疗导致的中性粒细胞减少症(CIN)造成化疗延迟(5.0%,95%CI:2.5%~7.5%),289例RDI≥85%(96%,95%CI:93.8%~98.2%),14例(4.7%,95%CI:2.3%~7.1%)化疗期间出现FN。结论隔日非格司亭用于支持原发性乳腺癌剂量密集型新辅助化疗(ddEC)可行。

Objective To retrospectively assess the efficacy and safety of short-term filgrastim in supporting dose-dense neoadjuvant chemotherapy(ddEC)for primary breast cancer based on a single database,in order to examine the feasibility of this method.Methods Data of patients who received dose dense neoadjuvant chemotherapy with support of short-term filgrastim at Peking University Cancer Hospital Breast Cancer Prevention and Treatment Center from July 2015 to June 2018 were retrospectively collected.All of these patients were planned to receive four cycles of ddEC(Epirubicin 100 mg/m2 and cyclophosphamide 600 mg/m2)with the usage of rhG-CSF as follows:Filgrastim 200-300μg/d on days 4,6,8,and 10.The relative dose intensity(RDI)was calculated based on chemotherapy delay and the number of dosage reductions,as well as febrile neutropenia(FN).Results A total of 301 patients were enrolled in this study.Chemotherapy induced neutropenia related chemotherapy delay occurred in 15 patients(5.0%;95%confidence interval[CI]:2.5%~7.5%),289 patients achieved an RDI≥85%(96%;95CI:93.8%~98.2%),and FN occurred in 14 patients(4.7%;95%CI:2.3%~7.1%).Conclusion According to this study,short-term filgrastim is feasible in supporting four cycles of neoadjuvant chemotherapy for primary breast cancer.