[A case report: neutropenia grade IV and febrile neutropenia in a metastatic breast cancer patient treated with palliative chemotherapy cyclophosphamide/myocet].

BACKGROUND Febrile neutropenia is a major toxicity of myelosuppressive chemotherapy. It is a potentially fatal complication which leads to increase in morbidity, mortality and treatment costs. Myeloid growth factors (colony-stimulating factors - CSFs) can effectively reduce the incidence of severe neutropenia in patients treated with high-risk chemotherapy regimens in both curative and palliative therapy. CASE We present a case of the 45-year-old metastatic breast cancer patient treated with palliative chemotherapy cyclophosphamide/Myocet who repeatedly presented with severe neutropenia, including febrile neutropenia after the second cycle of chemotherapy. Grade IV neutropenia was successfully managed with the combination of antibiotic and antimycotic drugs administered together with filgrastim. The second cycle of chemotherapy was complicated with a febrile neutropenia episode despite previous prophylactic use of pegfilgrastim. There was a complete restitution in white blood count after ten days of antibiotic and antimycotic therapy (without additional use of CSF). However, the chemotherapy had to be reduced by 25% since the third cycle and Myocet monotherapy was used since the fourth cycle. With the prophylactic use of five doses of filgrastim there was no adverse event of myelotoxicity in the fifth and sixth cycle. CONCLUSION This case demonstrates the development of myelotoxicity in chemotherapy treated patient and the use of myeloid growth factors for the prevention and treatment of febrile neutropenia. A dose reduction was required despite the use of GSF.