Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now?

Abstract

Updated international guidelines published in 2006 have broadened the scope for the use of granulocyte colony-stimulating factor (G-CSF) in supporting delivery of myelosuppressive chemotherapy. G-CSF prophylaxis is now recommended when the overall risk of febrile neutropenia (FN) due to regimen and individual patient factors is ≥20%, for supporting dose-dense and dose-intense chemotherapy and to help maintain dose density where dose reductions have been shown to compromise outcomes. Indeed, there is now a large body of evidence for the efficacy of G-CSFs in supporting dose-dense chemotherapy. Predictive tools that can help target those patients who are most at risk of FN are now becoming available. Recent analyses have shown that, by reducing the risk of FN and chemotherapy dose delays and reductions, G-CSF prophylaxis can potentially enhance survival benefits in patients receiving chemotherapy in curative settings. Accumulating data from ‘real-world’ clinical practice settings indicate that patients often receive abbreviated courses of daily G-CSF and consequently obtain a reduced level of FN protection. A single dose of PEGylated G-CSF (pegfilgrastim) may provide a more effective, as well as a more convenient, alternative to daily G-CSF. Prospective studies are needed to validate the importance of delivering the full dose intensity of standard chemotherapy regimens, with G-CSF support where appropriate, across a range of settings. These studies should also incorporate prospective evaluation of risk stratification for neutropenia and its complications.

Estudio de costo-beneficio del tratamiento profiláctico de la neutropenia febril con pegfilgrastim versus filgrastim en pacientes pediátricos con tumores sólidos

“…En la actualidad se cuenta con pocos estudios de farmacoeconomía, que serían de gran importancia, ya que servirían como herramienta para la toma de decisiones. De acuerdo a algunos estudios realizados, el uso de la forma pegilada es más eficaz que el filgrastim, por la disminución tanto del costo como de los eventos de NF [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] . El análisis de costo-eficacia analizando los años de vida ganados en pacientes pediátricos sobrevivientes tratados con filgrastim versus pegfilgrastim es objeto de un nuevo estudio, que aún está inconcluso, pero podría inferirse que se evidenciará la eficacia a largo plazo.…”

“…Los costos asociados a hospitalizaciones por NF se agregan de manera significativa a los costos médicos directos del tratamiento del cáncer y suponen una pesada carga financiera en la atención global de estos pacientes [1][2][3][4] . Los individuos que presentan NF pueden ser tratados en forma hospitalaria o ambulatoria de acuerdo al riesgo de complicaciones 5 .…”

How many neutrophils are enough (redux, redux)?

“…Clinical experience now suggests that the use of G-CSF to prevent bone marrow-depressive effects of chemotherapy in patients at high risk for neutropenia is far more efficacious than using it to treat neutropenia once it has occurred (8,29). Accordingly, it may be that the most useful clinical application of this new equation will be to use it prospectively in conjunction with other predictive tools (29), including low-tech methods such as the one devised by Wright et al (12), to assess the likelihood that chemotherapy will cause the tissue bactericidal activity of a patient's neutrophils to fall below the CNC and/or into regions of bacterial bistability.…”

“…Accordingly, it may be that the most useful clinical application of this new equation will be to use it prospectively in conjunction with other predictive tools (29), including low-tech methods such as the one devised by Wright et al (12), to assess the likelihood that chemotherapy will cause the tissue bactericidal activity of a patient's neutrophils to fall below the CNC and/or into regions of bacterial bistability.…”

Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review

“…(11) PP G-CSF could lead to lower FNmanagement costs and improved patient quality of life due to a reduction in FN event rate, and may also be associated with lower FN-related mortality rates and/or improved long-term cancer survival due to improved chemotherapy delivery. (12,13,14,15,16) PP G-CSF is also associated with significant drug acquisition costs that should be examined within the context of all potential downstream cost savings, quality of life improvements and survival benefits. (17) The adoption of PP G-CSF for FN prevention in various health care jurisdictions could be affected by its value for money (i.e.…”