Darbepoetin Alfa as Primary Prophylaxis of Anemia in Patients with Breast Cancer Treated Preoperatively with Docetaxel/Doxorubicin/Cyclophosphamide

BackgroundAt present, the combination of docetaxel/doxorubicin/cyclophosphamide (TAC) is considered a treatment option for patients with node-positive primary breast cancer; however, treatment is associated with grade 1–4 anemia in up to 95% of patients (grade 2–4 in 36%).Patients and MethodsWe prospectively investigated the use of a primary prophylaxis with darbepoetin alfa once every 3 weeks in 35 patients receiving 6–8 cycles of TAC as neoadjuvant treatment for breast cancer. Darbepoetin alfa treatment was started on day 1 of a TAC cycle if hemoglobin (Hb) level was ≤ 14 g/dL. The dose was adapted to 9 μg/kg if Hb level was ≤ 13 g/dL on day 21 of the previous cycle, to 4.5 μg/kg if Hb level was between 13 g/dL and 14 g/dL, and was discontinued if Hb level increased to ≥ 14 g/dL. The primary aim was to prevent Hb levels ≤ 12 g/dL before surgery.ResultsDuring 112 (50.2%) and 93 (41.7%) of 223 cycles, 4.5 μg/kg and 9 μg/kg of darbepoetin alfa were given, respectively. The dose was decreased from 9 μg/kg to 4.5 μg/kg in 21 patients (60%) and in 28 cycles (12.4%). Treatment was discontinued because of Hb levels > 14 g/dL in 12 patients (34.3%) and in 13 cycles (5.4%). Hemoglobin level on day 21 of the last cycle was ≤ 12 g/dL in 4 patients (11.4%). Eighteen patients (51.4%) during 36 cycles (16.1%) showed Hb levels ≤ 12 g/dL throughout treatment. No National Cancer Institute Common Toxicity Criteria grade 2–4 anemia was observed. Symptoms of fatigue (Functional Assessment of Cancer Therapy–Anemia) decreased slightly throughout treatment.ConclusionAnemia during TAC chemotherapy can be avoided by a single injection of darbepoetin alfa every 3 weeks.