Incidence of Anaemia and Thrombocytopenia Following Breast Cancer Chemotherapeutic Regimens AC-T, AC-T+ Ca, and AC-T+Tr IN in a Tertiary Care Center
Authors: S Arun , Mohamedali Seema P. , T Ajay Kumar , M Anuradha 
Published: August 2024

BACKGROUND: In breast cancer, the most common regimen used for the neoadjuvant and adjuvant nonmetastatic setting is 4 cycles of adriamycin and cyclophosphamide followed by docetaxel, docetaxel + trastuzumab, docetaxel, and carboplatin. (1)
Patients with breast cancer were treated with three different chemotherapeutic regimens, namely, AC-T (adriamycin and cyclophosphamide followed by docetaxel) regimen I, AC-T+Ca (adriamycin and cyclophosphamide followed by docetaxel and carboplatin) regimen II, and AC-T+Tr (adriamycin and cyclophosphamide followed by docetaxel and trastuzumab) regimen III, at a tertiary care hospital. Of these, myelosuppression was the major concern in treatment follow-ups. Here, I reviewed the incidence and management of anemia during the post-chemotherapy period.
METHODS: A prospective open-label observational comparative study was performed to evaluate the incidence of anemia and thrombocytopenia among three regimens, namely, the chemotherapy regimen AC-T, Regimen II AC-T+Ca, and Regimen III AC-T+Tr. All enrolled patients received pegfilgrastim/filgrastim prophylactically or as a part of the case of myelosuppression. The regimen I enrolled and completed a study of 38 patients, regimen II 40 patients, and regimen III 46 patients. All patients were subjected to statistical analysis using SPSS.
RESULTS: A total of 882 (88.9%) episodes of anemia (all grades) were observed among a total of 992 cycles of chemotherapy. Twenty-seven patients in Regimen I and II and 31 patients in Regimen III had at least one episode of anemia (grade 2 or above) during their chemotherapy cycles. Overall, 293 episodes were Grade 2, 21 episodes were Grade 3, and 3 episodes were Grade 4 anemia among the 3 study regimens. The mean incidence of anemia in regimen I in the initial 4 cycles was 3.4+/- 1.1, in the final 4 cycles, it was 3.7± 0.6, and in the overall 8 cycles was 7.1± 1.5. In regimen II, as in the initial 4 cycles:3.5+0.8, in the final 4 cycles: 3.9+0.4, and in the overall 8 cycles:7.4+1.1. In regimen III, as in the initial 4 cycles: 3.3+1; in the final 4 cycles: 3.7+ 0.6; and in the overall 8 cycles: 7.1+1.5. The mean incidence of all grades of anemia was comparable among the 3 study regimens, with a mean incidence of 7.1 in regimen I, 7.4 in regimen II, and 7.1 in regimen III over 8 cycles of chemotherapy. There was no statistically significant difference in the mean incidence of anemia among the 3 study groups.
A total of 109 episodes of thrombocytopenia out of 992 cycles of chemotherapy (10.9%) were observed. In the initial 4 cycles of chemotherapy, 44 episodes occurred, and in the final 4 cycles, 65 episodes occurred. Grade 2 or above thrombocytopenia resulting from at least one episode during the treatment period was reported in 6 patients in regimen I, 5 patients in regimen II, and 1 patient in regimen III. Of the total thrombocytopenia grades 2 and above, only 6 episodes in regimen I, 5 episodes in regimen II, and 2 episodes in regimen III were noted. The mean incidence of thrombocytopenia in regimen I in the initial 4 cycles: 0.1+ 0.5; in the final 4 cycles: 0.2+ 0.6, and in the overall 8 cycles: 0.3+ 1. In regimen II, the initial 4 cycles, were 0.1+ 0.3; in the final 4 cycles0.3+0.6; and in the overall 8 cycles, 0.4+0.7. In regimen III, as in the initial 4 cycles:0+0; in the final 4 cycles: 0.1+ 0.4; and in the overall 8 cycles:0.1+0.4. The mean incidence of thrombocytopenia of all grades was comparable among the 3 study regimens, with 0.3 in regimen I, 0.4 in regimen II, and 0.1 in regimen III over 8 cycles of chemotherapy. There was no statistically significant difference in the mean incidence of thrombocytopenia among the 3 study regimens.
CONCLUSION: There was no significant difference in the incidence of anemiaamong the 3 regimens in the initial 4 chemo cycles, final 4 chemo cycles, or overall 8 cycles of chemotherapy. There was a statistically significant difference in the mean incidence of thrombocytopenia during the initial 4 cycles of chemotherapy among the 3 regimens. However, among the overall 8 cycles of chemotherapy, there was no statistically significant difference in the mean incidence of thrombocytopenia among the three regimens. A trend towards a decrease in the mean Hb value was observed towards later cycles of chemotherapy in the overall study population due to the cumulative toxicity of chemotherapy regimens in the bone marrow.