Use of G-CSF to Sustain Dose Intensity in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Pilot Study

Abstract

Background Adjuvant chemotherapy for breast cancer is frequently accompanied by neutropenia requiring dose reduction or treatment delay that can potentially compromise therapeutic effectiveness. Recombinant granulocyte-colony stimulating factor (G-CSF) reduces the duration and severity of neutropenia. Methods Nineteen patients with newly diagnosed breast cancer receiving adjuvant systemic chemotherapy met criteria for dose reduction or treatment delay due to neutropenia. All were treated with G-CSF. The mean duration of G-CSF therapy was five days. Results An increase in mean absolute neutrophil count was seen in cycles with G-CSF. Chemotherapy treatment was delayed less often following the use of G-CSF. Conclusions Breast cancer patients receiving adjuvant chemotherapy who face treatment delays or dose reductions can continue on full-dose intensity therapy using supportive G-CSF. Prospective trials are needed to accurately measure the impact of G-CSF on dose intensity and long-term disease control.

Chemotherapy characteristics are important predictors of primary prophylactic CSF administration in older patients with breast cancer

“…In spite of its success in breast cancer treatment and management, the use of chemotherapy is restricted by toxicities. Neutropenia, one among the most serious acute toxicities, can lead to chemotherapy dose reductions, delays, or discontinuation, thereby diminishing chemotherapy's efficacy in cancer patients [10][11][12][13][14]. Neutropenia and its complications also involve a significant increase in expenditures due to hospitalizations and aggressive systemic antibiotics administration [15][16][17][18][19].…”

Temporal and Geographic Variation in the Use of Hematopoietic Growth Factors in Older Women Receiving Breast Cancer Chemotherapy: Findings From a Large Population-Based Cohort

“…1,3 More recently, hematopoietic growth factors have played a major role in preventing infection in cancer patients and shortening the duration of neutropenia in patients receiving chemotherapy. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] As a result, patients can better tolerate the standard chemotherapy regimens and may be able to tolerate the higher doses of chemotherapeutic agents, thereby improving therapeutic outcomes. 3,[9][10][11] During the last decade, numerous clinical trials and meta-analyses have demonstrated the efficacy of colony-stimulating factors (CSFs) in reducing neutropenia and shortening duration of hospitalization among patients with various cancers and all age groups.…”

Effect of primary prophylactic G-CSF use on systemic therapy administration for elderly breast cancer patients

“…Since primary prophylaxis of neutropenia is predominantly geared toward sustaining chemotherapy dose for the estimates intensity the findings in this study emphasize the clinical importance of primary prophylactic G-CSF administration [17,71]. The study also found that systemic therapy provision is further enhanced by ensuring adequate duration of primary prophylactic G-CSF administration.…”

“…Previous clinical trials and other studies found that primary prophylactic G-CSF administration increased adherence to preplanned chemotherapy regimens, improved administration of adequate chemotherapy dose intensity, and facilitated the ability to increase the dose intensity when medically indicated [10,17,29,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70]. This study is the first to look at the effect of primary prophylactic G-CSF on chemotherapy administration using a national sample of elderly women with breast cancer.…”

“…Chemotherapy-induced myelosuppression including neutropenia is one of the most common reasons for chemotherapy dose reductions, delays, or discontinuation [10][11][12]. Chemotherapy dose reductions and delays make it difficult to prevent tumor re-growth, reduce chemotherapy effectiveness, increase the probability of recurrence and mortality, and might also increase the overall treatment costs [10,11,[13][14][15][16][17][18][19][20]. Thus, dose reduction to control toxicity is referred to as ''killing with kindness'' [19].…”