Impact of protocol change on individual factors related to course of adverse reactions to chemotherapy for breast cancer

• Published in: Supportive care in cancer Vol. 28; no. 1; pp. 395 - 403
• Main Authors: Paula, Daniela Polessa, do Brasil Costa, Vanessa I., Jorge, Rosane V., Nobre, Flávio F.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2020; Springer; Springer Nature B.V
• Subjects: Abdominal Pain - chemically induced; Abdominal Pain - epidemiology; Abdominal Pain - genetics; Adult; Aged; Alcohol Oxidoreductases - genetics; Analysis; Anthracyclines; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Brazil - epidemiology; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - genetics; Cancer; Chemotherapy; Cohort Studies; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cytochrome P-450 CYP2B6 - genetics; Diarrhea; Diarrhea - chemically induced; Diarrhea - epidemiology; Diarrhea - genetics; Docetaxel - administration & dosage; Docetaxel - adverse effects; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Drug administration; Drug dosages; Drug Substitution - methods; Drug Substitution - statistics & numerical data; Drug-Related Side Effects and Adverse Reactions - drug therapy; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - genetics; Female; Fluorouracil; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Genetic aspects; Genetic polymorphisms; Genetic Predisposition to Disease; Health aspects; Hematology; Humans; Longitudinal Studies; Medicine; Medicine & Public Health; Middle Aged; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Pharmacogenomic Testing; Pharmacology; Polymorphism; Polymorphism, Single Nucleotide; Postmenopausal women; Rehabilitation Medicine; Side effects; Brazil; Chemotherapy; Adverse reactions; Breast cancer; Polymorphisms; Longitudinal models
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-019-04841-x

Purpose Asthenia, myalgia, arthralgia, mucositis, abdominal pain, diarrhea, and neutropenia are adverse reactions commonly reported by women undergoing chemotherapy. Traditional approaches do not take into account the effect that chemotherapeutic changes and variable interactions can cause in adverse reactions. We aimed to identify the impact of the change of a chemotherapy protocol within the same treatment in profiles associated with adverse reactions. Methods A total of 166 women admitted to the Brazilian National Institute of Cancer (INCA) were followed. Polymorphisms, clinical variables, and FAC-D protocols (3 cycles of cyclophosphamide, 5-fluorouracil, and doxorubicin followed by 3 cycles of docetaxel) composed the set of independent variables analyzed. Reaction levels were recorded at the end of each chemotherapy cycle via interviews. Marginal models were fitted. Results The results of marginal models for non-hematological reactions revealed that the docetaxel phase was associated with increased reaction levels compared with the FAC phase. In addition, the set of factors associated with the reactions changed in each protocol. The post-menopausal status was related to high levels of asthenia in docetaxel protocol whereas CYP2B6 polymorphism (rs3745274) was related to high levels in FAC protocol. Regarding the docetaxel phase, high levels of abdominal pain and mucositis were related to CBR3 gene (rs8133052) polymorphism and diabetes respectively. Conclusion The results suggest the need for monitoring non-hematological reactions during the docetaxel phase of FAC-D treatment. The factors related to more severe reactions depend on the chemotherapy protocol used.