Breast cancer in patients with sickle cell disease can be treated safely with weekly paclitaxel.

Breast cancer is the most common malignancy among females; nevertheless, so far no data is available in the literature on the safety of oncological treatments in patients with sickle cell disease (SCD). Here we report a case of a 39-year-woman with SCD who presented with metastatic breast cancer, and was treated accordingly with weekly paclitaxel 80 mg/m2 day one, 8, and 15 every 28 days as a standard regimen for metastatic breast cancer. She managed to complete the full course of chemotherapy (18 doses) of weekly treatment without any dose reductions or delays. The main side effects were: grade 1 nausea; and grade 2 mucositis. However, surprisingly there was no episode of febrile neutropenia, anemia, or thrombocytopenia. Moreover, she had no vaso-occlusive crisis while on chemotherapy. Therefore, weekly paclitaxel is both safe and well tolerated in SCD patients with breast cancer.

Are patients in clinical trials representative of the general population? Dose intensity and toxicities associated with FE100C-D chemotherapy in a non-trial population of node positive breast cancer patients compared with PACS-01 trial group.

PURPOSE: In our institution, adjuvant taxanes are currently offered to fit, node positive breast cancer patients who are either Her2 positive (any ER/PR) or triple negative (ER/PR/Her2 negative). The FE(100)C-D (FE(100)C × 3→docetaxel 100mg/m(2) × 3) regime, based on the PACS 01 trial [Roche H, Fumoleau P, Spielmann M, et al. Sequential Adjuvant Epirubicin-Based and Docetaxel Chemotherapy for node positive Breast Cancer Patients: The FNCLCC PACS 01 Trial. J Clin Oncol 2006;24:5664-5671] is used. We retrospectively audited our experience with FE(100)C-D at The Beatson West of Scotland Cancer Centre and one representative district general hospital (DGH), Falkirk and District Royal Infirmary (FDRI). PATIENTS AND METHODS: Over a two year period, 101 patients commenced adjuvant FE(100)C-D chemotherapy. Data was matched with the FE(100)C-D arm of the PACS 01 trial. RESULTS: Median age was 54 years. Twenty-six patients (26%) had ≥ 1 episode of febrile neutropaenia (FN), including one fatal episode. Twenty-nine percent of patients required treatment interruption ≥ 1 week. Thirty percent of patients had dose reductions. Thirty percent of patients received <90% dose intensity of docetaxel. CONCLUSION: The FN rate was substantially higher and docetaxel dose intensity substantially lower in our unselected sample of patients than in the reference study.(1) This 'real-life' data illustrates the problems of applying clinical trial data to the more generalised patient population.