Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update

Abstract

Prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available. Primary prophylaxis is recommended for the prevention of febrile neutropenia in patients who are at high risk on the basis of age, medical history, disease characteristics, and myelotoxicity of the chemotherapy regimen. Dose-dense regimens that require CSFs should only be used within an appropriately designed clinical trial or if supported by convincing efficacy data. Current recommendations for the management of patients exposed to lethal doses of total-body radiotherapy, but not doses high enough to lead to certain death as a result of injury to other organs, include the prompt administration of CSFs.

Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia

“…Although clinical guidelines3, 4, 5, 6 recommend consideration of patient‐level risk factors when making G‐CSF prophylaxis decisions, it is not clear how prophylaxis should be best directed based on the presence of these patient‐level risk factors. A risk prediction model incorporating all relevant patient‐level risk factors is thus needed to guide prophylactic decisions.…”

“…The following FN risk categories were considered in the reclassification analysis described above: <5%, 5% to <10%, and ≥10%. These ranges were chosen as it has been reported that approximately half of FN events occur in the first chemotherapy cycle;3, 17 therefore, they are likely equivalent to approximately <10%, 10% to 20%, and >20% FN risk over the chemotherapy course, which are cutoffs used in clinical guidelines 3, 4, 5, 6…”

“…Risk of developing FN is affected by chemotherapy regimens, patient characteristics, and disease characteristics. Clinical guidelines recommend primary prophylaxis with granulocyte colony‐stimulating factor (G‐CSF) in patients receiving high‐risk chemotherapy regimens (>20% risk in a chemotherapy course) and recommend consideration of G‐CSF prophylaxis for patients receiving intermediate‐risk chemotherapy regimens (10%‐20% risk in a chemotherapy course) who have additional risk factors 3, 4, 5, 6. Therefore, FN risk prediction tools incorporating patient and disease characteristics for individual patients could inform the clinical use of G‐CSF.…”

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

“…(1,2) Patients developing FN are often prescribed granulocytecolony stimulating factors (G-CSF) with subsequent treatment cycles in an attempt to reduce the risk of further FN events (secondary prophylaxis; SP) and maintain chemotherapy relative dose intensity (RDI). (5,6,7) Current practice guidelines recommend G-CSF from the first cycle of chemotherapy (primary prophylaxis; PP) if the predicted FN risk is 20% or higher. (5,6,7) Globally, adjuvant chemotherapy for breast cancer often consists of taxane-based regimes such as TAC (Docetaxel, Doxorubicin, Cyclophosphamide), FEC-D (Fluorouracil, Epirubicin, Cyclophosphamide, Docetaxel) and TC (Docetaxel, Cyclophosphamide).…”

“…(5,6,7) Current practice guidelines recommend G-CSF from the first cycle of chemotherapy (primary prophylaxis; PP) if the predicted FN risk is 20% or higher. (5,6,7) Globally, adjuvant chemotherapy for breast cancer often consists of taxane-based regimes such as TAC (Docetaxel, Doxorubicin, Cyclophosphamide), FEC-D (Fluorouracil, Epirubicin, Cyclophosphamide, Docetaxel) and TC (Docetaxel, Cyclophosphamide). (8,9,10) PP, as opposed to SP, is currently recommended for most patients treated with these regimens given the ≥ 20% FN risk observed with these regimens outside of clinical trials.…”