Real world experience with dose dense ac-paclitaxel: Two canadian cancer centers' experience

Early breast cancer treatment with dose dense Adriamycin-Cyclophosphamide and Paclitaxel (AC-P) has been shown to increase survival. However, it is commonly associated with neutropenia, anemia or both. This retrospective chart review study was done to evaluate the real world experience with this regimen and included a series of 83 adult women from the London Regional Cancer Program and 50 patients from the Windsor Regional Cancer Center who were treated with dose dense adjuvant AC-P for early breast cancer from January 2009 to August 2012. Toxicities like febrile neutropenia (FN) and anemia based on NCIC-CTC v2 criteria and grades were recorded along with the use of erythropoietin stimulating agents (ESA), Neupogen or Neulasta, and blood transfusion. The majority of our patients (88.72%) were able to complete all 8 cycles of AC-Taxol, although 32 of these patients (24.06%) experienced delay during their treatment. Grade 3 anemia was seen in one patient after cycle #4 and increased to two patients after both cycles 5 and 7. Only one patient developed grade 4 anemia, observed in the 5th cycle. Blood transfusion was given to sixteen patients and three patients received ESA. The incidence of febrile neutropenia was only 3.00%. The majority of our patients completed all 8 cycles of dose dense AC-Paclitaxel without any delay. The use of Neupogen and Neulasta effectively kept the incidence of FN to 3.00% and only a minority of patients experienced anemia requiring transfusion or ESA. Based on our experience, the dose-dense schedule with AC-Paclitaxel is a feasible and tolerable regimen to treat patients with early breast cancer.