Influence of capping chemotherapy prescriptions on efficacy and tolerability in medium and high-risk early-stage breast cancer

Capping body surface area (BSA) at 2.0 m² is a common clinical practice. This empirical practice is intended to mitigate toxicities. In this context, the objective of this study was to investigate in curative situation whether capping chemotherapy prescriptions at 2.0 m² had an influence on the efficacy and tolerance of treatment in patients diagnosed with early-stage breast cancer. Data from patients with a body surface area (BSA) greater than 2.0 m² who received treatment for medium and high-risk early-stage breast cancer, either in (neo)adjuvant settings, from January 1, 2010, to December 31, 2018, were examined. Patients were divided into four categories based on the percentage of chemotherapy capping throughout the treatment duration: [90-100]: the reference group, representing fully capped chemotherapy with capping exceeding 90%; [50-90[: capped chemotherapy ranging from 50 to 90%; [10-50[: capped chemotherapy between 10% and 50%; and [0-10[: representing non-capped chemotherapy. A total of 130 patients were included in the analysis, with a median age at diagnosis of 57 years (Interquartile range (IQR): 48-63) and a mean BSA of 2.07 m². Chemotherapy was provided as an adjuvant treatment to 86.9% of the participants. Depending on the capping group, the hematological toxicities were almost similar in all groups whereas non-hematological toxicities were slightly higher in the capped group between [10-50[. Similarly, chemotherapy dose reduction was also higher in capped group between [10-50[in comparison with other groups. A significant difference was observed in non-hematological toxicities of grade ≥ 2 between the reference group [90-100] and the capping group [10-50[(OR 3.59; 95% CI [1.26-10.22], p = 0.017). Prospective studies are needed to support the practice of capping, particularly in curative situations.