Management of Febrile Neutropenia and Cardiac Toxicity in the Adjuvant Treatment of Breast Cancer

Although substantial progress has been made in optimizing the adjuvant treatment of breast cancer, many of the most important proven agents carry a risk for potentially severe toxicity. Taxanes can cause febrile neutropenia and related serious infections, and anthracyclines and trastuzumab are associated with a small risk of clinically significant cardiac toxicity. These adverse events can limit the ability to deliver adjuvant treatment because of needed dose reductions and scheduling delays, which may attenuate the effectiveness of regimens designed to improve survival or cure patients with early-stage breast cancer. A major goal of adjuvant therapy is to maximize efficacy while minimizing severe acute and long-term, treatment-related toxicities. This article discusses therapeutic strategies that can reduce life-threatening cardiac toxicity and febrile neutropenia resulting from adjuvant breast cancer therapy.