Cancer Treatment Today

Standard guidelines recommend prophylactic Neulasta or Neupogen for patients who are treated with chemotherapy regimens that produce a greater than 20% risk of febrile neutropenia. These guidelines do not apply to the elderly. Elderly patients are at a higher risk of febrile neutropenia following chemotherapy, with worse morbidity and mortality rates. However, good prospective trial data are lacking with respect to elderly cancer patients due to their relative exclusion from randomized clinical trials, which therefore limits specific recommendations relative to this patient group. An earlier Task Force(2003) said: “In several specific malignancies, there is a clear need for further well- designed studies and clinically applicable tools to assist the identification of elderly patients who will benefit most from prophylactic G-CSF.” More recently, a study in the elderly by Rahan et al found that: “PPG-CSF use is associated with reductions in in-patient healthcare utilization. These findings have implications for ASCO guidelines and Medicare coverage policies for PPG-CSF administration in elderly breast cancer patients.” Studies by Romileu and Balducci et la support prophylactic GCSF therapy and a review by Aspro et al in 2010 recommends it. It would be fair to say that the field is shifting toward generally recommending prophylactic growth factors in the elderly.

Repetto L . Greater risks of chemotherapy toxicity in elderly patients with cancer. J Support Care Oncol 2003;1 Suppl 2:18-24.

J. de Naurois et al,Management of febrile neutropenia: ESMO Clinical Practice Guidelines   Ann Oncol (2010) 21 (suppl 5): v252-v256.

EORTC Cancer in the Elderly Task Force guidelines for the use of
colony-stimulating factors in elderly patients with cancer, 2003, http://www.hompedin.org/download/paper/EORTGuideline.pdf

ERajan SS, Lyman GH, Stearns SC, Carpenter WR.ffect of primary prophylactic granulocyte-colony stimulating factor use on incidence of neutropenia hospitalizations for elderly early-stage breast cancer patients receiving chemotherapy.Med Care. 2011 Jul;49(7):649-57.

Romieu G, Clemens M, Mahlberg R, Fargeot P, Constenla M, Schutte M, Easton V, Skacel T, Bacon P, Brugger W. Pegfilgrastim supports delivery of FEC-100 chemotherapy in elderly patients with high risk breast cancer: a randomized phase 2 trial. Crit Rev Oncol Hematol. 2007;64:64–72.

Balducci L, Al-Halawani H, Charu V, Tam J, Shahin S, Dreiling L, Erchler WB. Elderly cancer patients receiving chemotherapy benefit from first-cycle pegfilgrastim. Oncologist. 2007;12:1416–1424.

Matti Aapro et al, Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now? Support Care Cancer. 2010 May; 18(5): 529–541.

See Lay version here