Anthracycline-based regimens with or without anti-human epidermal growth factor receptor (HER) 2 agents such as trastuzumab are effective in breast cancer treatment. Nevertheless, heart failure (HF) has become a significant side effect of these regimens. This study aimed to investigate the incidence and factors associated with HF in breast cancer patients treated with anthracyclines with or without trastuzumab. A retrospective cohort study was performed in patients with breast cancer who were treated with anthracyclines with or without trastuzumab between 1 January 2014 and 31 December 2018. The primary outcome was the incidence of HF. The secondary outcome was the risk factors associated with HF by using the univariable and multivariable cox-proportional hazard model. A total of 475 breast cancer patients were enrolled with a median follow-up time of 2.88 years (interquartile range (IQR), 1.59–3.93). The incidence of HF was 3.2%, corresponding to an incidence rate of 11.1 per 1000 person-years. The increased risk of HF was seen in patients receiving a combination of anthracycline and trastuzumab therapy, patients treated with radiotherapy or palliative-intent chemotherapy, and baseline left ventricular ejection fraction <65%, respectively. There were no statistically significant differences in other risk factors for HF, such as age, cardiovascular comorbidities, and cumulative doxorubicin dose. In conclusion, the incidence of HF was consistently high in patients receiving combination anthracyclines trastuzumab regimens. A reduced baseline left ventricular ejection fraction, radiotherapy, and palliative-intent chemotherapy were associated with an increased risk of HF. Intensive cardiac monitoring in breast cancer patients with an increased risk of HF should be advised to prevent undesired cardiac outcomes.

Background: Acute myeloid leukemia (AML) with febrile neutropenia (FN) had a higher incidence among hematologic malignancies. The varied incidence and risk factors predictive of FN among patients with AML were reported. Hence, this study aimed to evaluate the incidence and risk factors associated with FN in AML patients who underwent the induction phase of chemotherapy. Material and Methods: In this retrospective cohort study, patients who were newly diagnosed with AML and receiving the induction phase of the idarubicin/cytarabine 3+7 regimen or 2+5 were included between January 2008 and December 2021. The primary outcome was an incidence of FN. Risk factors for FN and the causative pathogen were presented as secondary outcomes. The Kaplan-Meier and Cox-proportional hazard models evaluated the relationship between risk factors and FN. Results: A hundred and forty-one eligible patients with a mean age of 40.7 years (standard deviation [SD] = 13.4 years) were enrolled. Among these patients, 92.2% had an Eastern Cooperative Oncology Group score of 1–2. Twenty-five patients (17.7%) received the 2+5 regimen, and 116 (82.3%) underwent the 3=7 regimen. The average length of hospital stay was 33.9 days (SD = 7.0 days). The median absolute neutrophil count was 1,784.8 cells/mm3 (interquartile range [IQR] = 4,880.1 cells/mm3). Sixty-four (45.4%) of patients received granulocyte colony stimulating factor. The incidence of FN among patients with AML during the induction phase was 88.7%. The median time to FN was 6 days (IQR = 7.0 days). There was no significance in univariate and multivariable analyses for potential risk factors associated with FN. Gram-positive bacteria were identified as the predominant isolates, and Enterococci spp. was the most common pathogen. Conclusion: This study revealed a high incidence of FN among newly diagnosed AML patients receiving induction-phase chemotherapy. With some limitations, a significant association between FN and risk factors was not determined.

Background: Non-small cell lung cancer (NSCLC) is a major cause of cancer-related mortality, for which mutations in the epidermal growth factor receptor (EGFR) gene are common in Asian populations. Erlotinib, an EGFR tyrosine kinase inhibitor, has been used as the first-line therapy for EGFR-mutated NSCLC. Generic erlotinib has been introduced in Thailand to increase accessibility, but efficacy and safety are major concerns. Objective: This study aimed to compare the efficacy and safety of generic versus originator erlotinib among Thai patients using real-world data from two quaternary hospitals. Methods: A retrospective cohort study collected data from medical record of advanced or metastatic EGFR-mutated NSCLC receiving either generic or originator erlotinib between September 2019 and September 2021 from Maharaj Nakorn Chiang Mai Hospital and Sunpasitthiprasong Hospital, Thailand. Primary outcomes were clinical benefit rate (CBR) at 12 months, progression-free survival (PFS) and treatment-related adverse events. Kaplan-Meier survival curve with log-rank test and the propensity score (PS)-adjusted models were employed to estimate the difference of response rate and safety between the generic vs. the originator erlotinib. Results: One hundred and seven patients were included. CBR at 12 months of the generic vs. originator erlotinib were 75.4 and 74.0% (adjusted HR 1.47 [95%CI 0.45-4.83, p= 0.519]). Median PFS of the generic vs. originator erlotinib were 15.2 months and 18.9 months (adjusted HR 1.98 [95%CI 0.99-3.94, p = 0.053]). The incidence of any adverse events for the generic vs. originator was 21.0 and 36.0% (adjusted OR 0.84 [95%CI 0.26-2.71, p = 0.770]). Most adverse events comprised mild skin toxicity, with no significant difference between the two groups (adjusted OR 1.03 [95%CI 0.31-3.43, p = 0.958]). Conclusions: No significant differences were noted regarding efficacy or safety between generic and originator erlotinib. These findings support the use of generic erlotinib as a cost-effective alternative in Thailand.