Metastatic breast cancer and neutropenia
With treatment for stage IV breast cancer, you may develop neutropenia as a result of taking certain medicines. This means you have lower than the normal amounts of neutrophils, a type of white blood cell that fights infection by killing harmful bacteria in the blood. The cancer itself can also cause neutropenia if it has spread to the bone, as it can crowd out healthy bone marrow cells.
Your risk of developing a serious infection from neutropenia is higher due to the effects of ongoing treatment. With bone metastases, you are also at higher risk because it affects the way bone marrow makes white blood cells, red blood cells, and platelets.
Both ongoing treatment and bone marrow metastasis put you at higher risk for febrile neutropenia. This condition causes a fever and greatly cuts the number of white blood cells your body needs to fight infection. Febrile neutropenia often results in a hospital stay. Once you have it, you are at higher risk for febrile neutropenia in the future.
Call your providers right away if you develop a temperature of 100.5 degrees Farenheit or higher during chemotherapy treatment, have shaking chills, or have any sign of infection. They can help figure out what to do.
If a certain treatment has a high risk of causing neutropenia, your doctor may prescribe a medicine called a growth factor to lower your risk. Growth factors may also be given to raise your white blood cell counts if they have already dropped. These may include
- filgrastim (Neupogen) or a biosimilar, a medicine designed to be very similar to a biological medicine and work the same way in the body, given once or twice a day by vein or as an injection under the skin for about 1-2 weeks 24 hours after every chemotherapy cycle
- pegfilgrastim (Neulasta), or a biosimilar, given by as an injection under the skin 24 hours after every chemotherapy cycle
If these medicines are not enough to get your white blood cell counts back up, your doctor may lower the dose of your medicine, delay your treatment by an extra week or in some cases temporarily stop treatment. You might also be able to switch to a different medicine.
It’s possible the medicine could work as well against the breast cancer at a lower dose or on a less frequent schedule. Talk with your providers about how they will monitor the impact of any changes to your treatment. You and your providers will decide together whether continuing with a certain treatment is right for you.
Sometimes people don’t want to report side effects because they are worried that if the dose or timing of the medicine changes, the treatment will not be as effective. But most treatments have recommendations built-in to lower the dose or change the timing of the medicine if symptoms are of concern. Studies show that even if the dose is lowered or changed, the treatment will still work as well against the cancer. If the dose or change would not be effective, your healthcare providers would then change you to a different treatment.
Although one goal of your treatment is to keep the cancer under control for as long as possible, a second, equally important goal is to allow you to live a good life. Remember, your needs are an important part of your treatment plan. Open communication with your providers is very important. You and your providers will decide together whether continuing with a certain treatment is right for you.