Optimal use of recombinant granulocyte colony-stimulating factor with chemotherapy for solid tumors

Abstract

Neutropenia is a frequent complication of anticancer chemotherapy (CT) often associated with life-threatening infections, hospitalization, dose reduction and/or delay in the administration of CT. Administration of recombinant granulocyte colony-stimulating factor (rG-CSF) reduces the duration and the degree of CT-neutropenia. rG-CSF that stimulates both neutropoiesis and neutrophil function, has become an integral part of supportive care during cytotoxic CT, to prevent febrile neutropenia (FN), particularly in patients with a risk of FN ≥20%. International guidelines have standardized conditions for rG-CSF administration, however, some ‘gray zones’ still exist around optimal timing and tailoring of this therapy. We report here the results of a research project aimed to extend the consensus on the optimal use of rG-CSF in association with CT in patient with solid tumours. We also propose a recently developed pharmacodynamic model, based on the biological effects of CT and rG -CSF on bone marrow compartments that clearly indicates within the prophylactic rather than therapeutic setting the better way of rG-CSF administration.

Keywords::

• antineoplastic agents
• bone-marrow compartments
• chemotherapy-induced neutropenia
• international guidelines
• prophylaxis
• recombinant granulocyte colony-stimulating factor

Acknowledgements

We gratefullly thank Martina Torchio (Medical Oncologist at the University of Pavia) for helpful suggestions and careful revision.

Financial & competing interests disclosure

Marco Danova and Romano Danesi have participated on the scientific boards and received honoraria grants and funding from Amgen-Dompé. Marco Danova and Lucia Del Mastro were involved in the production of the 2010 Guidelines for the Management of the Haematopoietic Toxicity in Oncology for the Italian Association of Medical Oncology, AIOM (www.aiom.it/Attivita_Scientifica/Linea_Guida/2010/PDF/Fattori_crescita.2010.pdf; 2010). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial assistance was provided by Laurene Kelly at the IRCCS Foundation San Matteo, Pavia, utilizing personal funding from the corresponding author.