Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy—findings from clinical practice

Abstract

PurposeClinical practice adherence to current guidelines that recommend primary prophylaxis (PP) with granulocyte colony-stimulating factors (G-CSFs) for patients at high (≥20 %) overall risk of febrile neutropenia (FN) was evaluated.MethodsAdult patients with breast cancer, non-small cell lung cancer (NSCLC), small-cell lung cancer (SCLC), or ovarian cancer were enrolled if myelotoxic chemotherapy was planned, and they had an investigator-assessed overall FN risk ≥20 %. The primary outcome was FN incidence.ResultsIn total, 1,347 patients were analysed (breast cancer, n = 829; NSCLC, n = 224; SCLC, n = 137; ovarian cancer, n = 157). Patients with breast cancer exhibited fewer individual FN risk factors than patients with other cancers and were far more likely to have received a high-FN-risk chemotherapy regimen. However, a substantial proportion of all patients (45–80 % across tumour types) did not receive G-CSF PP in alignment with investigator risk assessment and guideline recommendations. FN occurred in 127 patients overall (9 %, 95% confidence interval (CI) 8–11 %), and incidence was higher in SCLC (15 %) than other tumour types (8 % in ovarian and NSCLC, 9 % in breast cancer). A post hoc analysis of G-CSF use indicated that G-CSF prophylaxis was not given within the recommended timeframe after chemotherapy (within 1–3 days) or was not continued across all cycles in 39 % of patients.ConclusionsFN risk assessment was predominantly based on clinical judgement and individual risk factors, and guidelines regarding G-CSF PP for patients at high FN risk were not consistently followed. Improved education of physicians may enable more fully informed neutropenia management in patients with solid tumours.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-013-2021-2) contains supplementary material, which is available to authorized users.

Prevention and Treatment of Chemotherapy-Induced Neutropenia with the Biosimilar Filgrastim: A Non-Interventional Observational Study of Clinical Practice Patterns

“…age ≥ 65 years, advanced disease, history of previous febrile neutropenia) [1,6,7]. However, data from real-world practice settings have indicated that administration of filgrastim does not always concur with guidelines, with patients either not treated or given shortened courses [2,8,9,10,11]. Such suboptimal use of filgrastim is associated with poorer outcomes; for example, the risk of hospitalization for neutropenia or infection has been reported to decline with each additional day of G-CSF prophylaxis in patients with various types of cancer [12].…”

An international, multicenter, prospective, observational study of neutropenia in patients being treated with lenalidomide + dexamethasone for relapsed or relapsed/refractory multiple myeloma (RR‐MM)

“…The median duration of daily G-CSF use was only one day, indicating it was generally administered as short courses or intermittent doses during a cycle. This contrasts with the cytotoxic chemotherapy setting, where daily G-CSF is given typically consecutively on the first 5-6 days of the cycle [14,17]. Pegfilgrastim was used in around one-third of patients who received G-CSF, and pegfilgrastimtreated patients appeared to be more heavily pretreated and have more comorbidities than patients treated with daily G-CSF patients, while they were also younger and more received the standard dose of lenalidomide.…”

Czynniki pobudzające granulopoezę są nadużywane w systemowym leczeniu onkologicznym

“…Ostatnio przeprowadzono międzynarodowe badanie obserwacyjne, którego celem było zweryfikowanie zgodności zastosowania w praktyce zaleceń dotyczących pierwotnej profilaktyki GN z zastosowaniem G-CSF u chorych otrzymujących chemioterapię obarczoną wysokim (≥ 20%) ryzykiem GN [19]. Ocena dotyczyła 1347 chorych na raka piersi, niedrobnokomórkowego i drobnokomórkowego raka płuca oraz raka jajnika.…”

“…Publikacja nie zawiera danych, które wskazywałyby na ewentualne szkody, które mogły-by wyniknąć z niestosowania tych zaleceń. Zwraca uwagę wysoki odsetek, blisko połowa programów chemioterapii, co do których nie można było ustalić stopnia ryzyka GN, co czyni stosowanie zaleceń pierwotnej profilaktyki bardzo problematycznym i pozostawia decyzję lekarza niesprecyzowanym przesłankom [19].…”