Exploring Febrile Neutropenia as Non-Cardiac Fatal Toxicities of Anthracycline-Based Chemotherapy: Incidence and Predictive Factors among Breast Cancer Patients – A Retrospective Analysis at Surin Hospital Cancer Center.

Abstract

     In the ongoing battle against breast cancer, chemotherapy remains a critical tool alongside immunotherapy and targeted therapy. Anthracycline-based regimens stand out as powerful chemotherapy agents in this fight. However, alongside therapeutic advancements, febrile neutropenia (FN) poses a significant challenge as a potentially fatal non-cardiac toxicity. Attention to managing FN is crucial for the safety and treatment success of breast cancer patients. We conducted a retrospective study from January 2020 to December 2022 at Surin Hospital Cancer Center, focusing on breast cancer patients treated with anthracycline-based chemotherapy. Our objective was to identify incidents and contributing factors to severe neutropenia and FN following chemotherapy. Prognostic factors were analyzed using a flexible parametric regression model in both univariate and multivariate analyses. The result showed that among the 174 eligible breast cancer patients included in the study, severe neutropenia (defined as ANC <100 cells/mm³) occurred in 2.9% of cases, while 4% developed FN, resulting in two deaths. Univariate analysis revealed associations between FN and severe neutropenia with age over 65, higher ECOG performance status scores, and comorbidities. However, in multivariate analysis, only an initial absolute neutrophil count below 3,000 cells/mm³ emerged as an independent predictor of FN (OR 8.449; 95% CI 1.165–61.290; P=0.035). Notably, the severity of neutropenia did not significantly vary based on patients’ nutritional statuses. In conclusion, the study highlights FN as a significant complication of anthracycline-based chemotherapy in breast cancer patients. The identification of baseline neutrophil count as a predictive factor emphasizes the importance of pre-chemotherapy screening and proactive management strategies to mitigate FN risk and improve patient outcomes.