Trends in Use of Bone Marrow Stimulators to Prevent Febrile Neutropenia

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Patients receiving chemotherapy frequently experience febrile neutropenia (FN), a dose-limiting toxicity that may disrupt planned chemotherapy administration (such as causing delays or dose reduction). This toxicity may necessitate hospitalization, which can be prolonged, costly, and may adversely affect patients’ quality of life.

Granulocyte-colony stimulating factors (G-CSF) are a class of bone marrow stimulating drugs (such as pegfilgrastim) that have demonstrated success in reducing the risk of FN. A recent study of older women in the US with early-stage breast cancer has examined real-world trends in the use of G-CSF to prevent FN.  

According to this research recently published in the Journal of Supportive Care in Cancer, the proportion of patients who received G-CSF at the start of their adjuvant chemotherapy (primary prophylaxis) increased substantially from 6% in 2002 to 71% in 2012.  Researchers explain that this increase may have several causes: the introduction of a more convenient, long-acting (single-administration) G-CSF in 2002, as well as changes in treatment guidelines for G-CSF prophylaxis and an increased use of chemotherapy regimens that are more likely to cause FN during the study period.  The researchers found that the risk of FN in the first cycle of chemotherapy increased during the study period. However, the adjusted risk of FN among patients receiving G-CSF primary prophylaxis tended to be lower than among those not receiving primary prophylaxis.

The study also found that a substantial proportion of patients received G-CSF for reactive or therapeutic reasons (for example, to treat FN after it had already occurred). Practice guideline recommendations do not support such use.  This study also reports that the reactive or therapeutic use of G-CSF saw a declining trend between 2002 and 2012, which is probably related, at least in part, to the increasing trend in the prophylactic use of G-CSF. 

These findings may have important implications for future investigations, providers, and other decision-makers in the provision of prophylactic care for patients with early-stage breast cancer in the US.

The authors of this Journal of Supportive Care in Cancer article collaborated in designing and implementing the study on which this publication is based.   

Goyal RK, Tzivelekis S, Rothman KJ, Candrilli SD, Kaye JA. Time trends in utilization of G-CSF prophylaxis and risk of febrile neutropenia in a Medicare population receiving adjuvant chemotherapy for early-stage breast cancer. Support Care Cancer. 2017 Sep 18. doi: 10.1007/s00520-017-3863-9 


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