The use of G-CSF after the administration of chemotherapy may be in several settings:
Administration of G-CSF is generally not recommended for routine treatment in patients with established fever and neutropenia. ASCO and ASH guidelines recommend routine use of Neulasta® or Neupogen (filgrastim) for patients with an overall risk of FN of 20% or greater. The NCCN guidelines state that for patients with a febrile neutropenia risk of 10% to 20%, prophylactic colony-stimulating factor use should be considered based on the treatment intent and the importance of chemotherapy dose delivery on schedule.Previous studies have suggested that prophylactic Neulasta can reduce the incidence of hospitalizations, decrease FN and allow better delivery of protocol doses of chemotherapy. The recommended dosage of Neulasta® is a single subcutaneous injection of 6 mg administered once per chemotherapy cycle. Neulasta® should not be administered in the period between 14 days before and 24 hours after administration of cytotoxic chemotherapy.
The supportive data was generated from 8 randomized clinical trials and 3 observational studies conducted between 1998 and 2005.
NCCN, Supportive Chemotherapy 2019
Thomas J. Smith, Kari Bohlke, Gary H. Lyman, Kenneth R. Carson, Jeffrey Crawford, Scott J. Cross, Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology 33, no. 28 (October 2015) 3199-3212.
Lyman GH, Kleiner JM. Summary and comparison of myeloid growth factor guidelines in patients receiving cancer chemotherapy. Cancer Treat Res. 2011;157:145-65.
Some specific regimens.
The reported rates of febrile neutropenia differ between studies of the TC(Taxotere/Cytoxan) studies. The Jones et al study, noted a trend toward more febrile neutropenia (FN; 5% v 2.5%, P = .07) in the TC group. A 2009 study(Soong et al) reported FN rates of up to 50%. While true rates of FN are beign assessed, I consider Neulasta appropriate for the TC regimen.
A recent study(Vandenberg et al) found that patients older than 65 had a 40% risk of febrile neutropenia with the AC regimen.
Carboplatin/paclitaxel result in a very low incidence of grade 4 neutropenia
Markman J, Zanotti K, Webster K, Belinson J, Peterson G, Kulp B, Markman M.Experience with the management of neutropenia in gynecologic cancer patients receiving carboplatin-based chemotherapy. Gynecol Oncol. 2004 Feb;92(2):592-5.
The recent 2005 ASCO guideline added that patients treated with palliative intent for metastatic disease should have thir dose reduced rather than use myeloid growth factors.
Désirée Caselli et al,Biosimilars in the management of neutropenia: focus on filgrastim.Biologics. 2016; 10: 1722.
Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56e93.
Christopher R. Flowers, Jerome Seidenfeld, Eric J. Bow, Clare Karten, Charise Gleason, Douglas K. Hawley, Nicole M. Kuderer, Amelia A. Langston, Kieren A. Marr, Kenneth V.I. Rolston and Scott D. Ramsey Antimicrobial Prophylaxis and Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology Clinical Practice Guidelin JCO January 14, 2013
Thomas J. Smith, Kari Bohlke, Gary H. Lyman, Kenneth R. Carson, Jeffrey Crawford, Scott J. Cross, John M. Goldberg, James L. Khatcheressian, Natasha B. Leighl, Cheryl L. Perkins, George Somlo, James L. Wade, Antoinette J. Wozniak and James O. Armitage, Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. JCO July 13, 2015
NCCN Supportive Care, Neutropenia, 2016.
Management of febrile neutropenia: ESMO Clinical Practice Guidelines Ann Oncol (2010) 21 (suppl 5): v252-v256.
Clark OAC, Lyman G, Castro AA, Clark LGO, Djulbegovic B. Colony stimulating factors for chemotherapy induced febrile neutropenia. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD003039
Adams, Jared R., Angelotta, Cara, Bennett, Charles L.
When the Risk of Febrile Neutropenia Is 20%, Prophylactic Colony-Stimulating Factor Use Is Clinically Effective, but Is It Cost-Effective? J Clin Oncol 2006 24: 2975-2977
Smith TJ, Khatcheressian J, Lyman GH: 2006 update of recommendations for the use of white blood cell growth factors: An evidence-based, clinical practice guideline. J Clin Oncol 24:3187-3205, 2006
Lyman GH: Guidelines of the National Comprehensive Cancer Network on the use of myeloid growth factors with cancer chemotherapy: A review of the evidence. J Natl Compr Canc Netw 3:557-571, 2005
D. Soong et al, High Rate of Febrile Neutropenia in Patients With Operable Breast Cancer Receiving Docetaxel and Cyclophosphamide, JCO September 10, 2009 vol. 27 no. 26 e101-e102
T. Vandenberg, BA MD, J. Younus, MD, and S. Al-Khayyat, MD Febrile neutropenia rates with adjuvant docetaxel and cyclophosphamide chemotherapy in early breast cancer: discrepancy between published reports and community practice—a retrospective analysis, Curr Oncol. 2010 April; 17(2): 2–3.
Alimta and carboplatin in second line studies have a risk of febrile neutropenia of 2.7-3.4%.
Ardizzoni A, Tiseo M, Boni L, et al: Pemetrexed versus pemetrexed and carboplatin as second-line chemotherapy in advanced nonsmall-cell lung cancer (NSCLC): Results of GOIRC 02-2006 randomized phase II study and pooled analysis with NVALT7 trial. J Clin Oncol 30:4501-4507, 2012.
2. Smit EF, Burgers SA, Biesma B, et al: Randomized phase II and pharmacogenetic study of pemetrexed compared with pemetrexed plus carboplatin in pretreated patients with advanced nonsmall-cell lung cancer.