Febrile neutropenia in patient with head and neck cancer treated with docetaxel, cisplatin and 5-fluorouracil (TPF protocol) - A comparison before and after the introduction of pegfilgrastim

The TPF protocol composed of docetaxel, cisplatine and 5-fluorouracil, is the most commonly used chemotherapy regimen for the treatment of head and neck cancer. Recently, the importance of maintaining a relative dose-intensity (RDI) has been shown. Therefore, the treatment and prevention of febrile neutropenia, which can reduce the RDI of the TPF protocol, are important. Here, we compare patient outcomes before and after the introduction of pegfilgrastim for primary prophylaxis. The first group is consisted of 60 patients (88 chemotherapy courses) treated between January 2011 and October 2014 who did not receive prophylaxis. The second group consisted of 14 patients (20 chemotherapy courses) treated between November 2014 and July 2016 using pegfilgrastim. We examined the frequency of neutropenia (grade 3 and 4), febrile neutropenia (FN) and treatment-related death, the amount of granulocyte-colony stimulating factor (G-CSF) used, the cost for FN treatment and the hospitalization period. In the first group, there were 74 neutropenia events, 34 cases of FN and 2 treatment-related deaths; the average hospitalization period was 18.5 days. In the second group, there were 74 neutropenia events, 34 case of FN, and 0 treatment-related death; the average hospitalization period was 18.5 days. The frequency of adverse events, the amount of G-CSF used, the cost for FN and the hospitalization period were all significantly reduced by the introduction of pegfilgrastim. In conclusion, the administration of pegfilgrastim for the primary prophylaxis of FN was effective when included in the TPF protocol for the treatment of head and neck cancer.