The aim of this study is to evaluate the hematologic and non-hematologic toxicity of adjuvant treatment with anthracyclines in G6PD deficient patients affected by breast cancer.
From July 2009 to May 2017, we enrolled 40 Caucasian female patients carrier of G6PD deficiency with non-metastatic breast cancer. They were treated with adjuvant chemotherapy including anthracyclines.
As for treatment, 30% of patients were treated with FEC regimen (Fluoruracil 500mg/m2 iv, Epirubicin 75-100 mg/m2i.v., Cyclophosphamide 500-600mg/m2 every three weeks) for 6 cycles. 70% of the women received chemotherapy including anthracyclines and taxanes: 55% with EC regimen (Epirubicin 90 mg/m2i.v. and Cyclophosphamide 600 mg/m2i.v. every two weeks) for 4 cycles and Paclitaxel 80mg/m2i.v. weekly for 12 cycles; 15% were treated with FEC regimen for 3 cycles and Docetaxel 100 mg/m2i.v. every three weeks for 3 cycles. Anemia of grade 1 (83,6%) or 2 (17,4%) occurred in 57,5% of patients. In 42,5% of patients no anemia occurred. Nobody had acute hemolytic anemia and nobody presented neutropenia or thrombocytopenia. Bilirubin levels were normal in all patients (0.2-1,2 mg/dl) such as reticulocytes count (0,5-1,5%).Haptoglobin levels (50-150 mg/dl) were normal too. In 65% of cases LDH levels were lightly increased (200-500 U/L), but this result was due to a G-CSF injection. A common trait that occurred in 100% of the patients was alopecia.Only 17,5% of patients reported fatigue of grade 1.37,5% reported nausea of grade 1 and 2. 5% of patients presented vomit. 7,5% of patients reported constipation of grade 1 or 2 and 2,5% presented diarrhea of grade 2.7,5% of patients reported oral mucositis of grade 1 or 2. Non-hematologic and hematologic adverse events occurred frequently in patients without G6PD mutations.
Despite this is retrospective data and the number of patients analysed in this study is limited, these results prove that the usage of anthracyclines regimen is safe in patients with G6PD deficiency. In the future most clinical trials are welcomed to improve clinical practice.
Clelia Donisi.
Has not received any funding.
All authors have declared no conflicts of interest.