Prophylaxis and treatment strategies for optimizing chemotherapy relative dose intensity

ABSTRACT

Introduction

A decrease in relative-dose intensity (RDI) of chemotherapy has been shown to be associated with poor patient outcomes in solid tumors and non-Hodgkin’s lymphoma. The actual delivered chemotherapy dose received by patients can be influenced by dose reductions and treatment delays, often due to toxicities, most commonly chemotherapy-induced neutropenia (CIN).

Areas covered

We review seminal evidence and more recent studies that have shown an association between higher RDI and improved patient survival. A smaller number of studies has shown no association between RDI and outcomes. These differences may be due to study limitations, including low power, differences in patient and disease characteristics, or the chemotherapeutic regimen. We describe guidelines recommendations to prevent and treat CIN with granulocyte-colony stimulating factor (G-CSF) and describe novel approaches to prevent neutropenia that are being developed that may provide greater value and be associated with fewer adverse events than standard G-CSF options.

Expert opinion

Maintaining RDI is important to ensure optimal patient outcomes. This can be achieved through the proper administration of G-CSF prophylaxis and treatment. Newer agents in development to treat and/or prevent CIN are entering regulatory review and may potentially change the treatment landscape for CIN in the future.

KEYWORDS:

• Chemotherapy-induced neutropenia
• G-CSF
• patient outcomes
• relative dose intensity
• dose intensity

Article highlights

• CIN is the most common adverse event leading to dose alterations and low RDI.

• The RDI of chemotherapy received is directly associated with patient outcomes.

• G-CSF prophylaxis is recommended to prevent CIN of select chemotherapy regimens.

• Novel drugs in development to prevent CIN may change the treatment landscape.

Declaration of interest

M Shayne has served as a consultant for BeyondSpring.

G Lyman’s institution has received funding from Amgen, Lyman has also served as a consultant for G1 Therapeutics, BeyondSpring, Samsung, TEVA and Merck.

DR Harvey’s institution that supports his salary received research funding from Abbisko, AbbVie, Actuate, Alkermes, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boston Biomedical, Calithera, Fujifilm, Genmab, GlaxoSmithKline, Infinity, lnhibRx, Lycera, Merck, Mersana, Meryx, Nektar, Pfizer, Puma, RAPT Therapeutics, Regeneron, Rgenix, Sanofi, Seattle Genetics, Sutro, Takeda, Xencor. Harvey has also served as a consultant with Amgen and GlaxoSmithKline.

Medical writing support was provided by Rebecca Bigelow (Publication Practice Counsel™; Truposha LLC), which was funded by BeyondSpring, Inc.

Reviewer disclosures

A reviewer on this manuscript holds equity in Matrix45, LLC. Matrix45 has had and/or currently holds contracts with Amgen, Roche, Sandoz/Novartis, Coherus, Teva, Hospira/Pfizer, Mylan (now Viatris).

Reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper received funding from BeyondSpring Inc.