Researchers from the University of Rochester, the University of Washington and Duke University have concluded that the prophylactic use of granulocyte-colony stimulating factor (G-CSF) reduces febrile neutropenia and early deaths due to infections in adult patients receiving chemotherapy. The details of this study appeared in the July 10, 2007 issue of the Journal of Clinical Oncology.

The administration of prophylactic Neupogen® (filgrastim) or Neulasta® (pegfilgrastim) to patients receiving chemotherapy accelerates neutrophil recovery, decreases the incidence of febrile neutropenia and improves delivery of protocol doses of chemotherapy. However, the addition of Neupogen or Neulasta does not improve survival in most studies.

The current review involved 17 randomized trials of Neupogen (n=10), Neulasta (n=1) or Granocyte® (lenograstim) (n=6). These trials included more than 3,000 patients receiving systemic chemotherapy. Infection-related mortality was 2.8% in the control group and 1.5% in the G-CSF group for a 45% reduction. Early mortality occurred in 5.7% of the control group and 3.4% of the G-CSF group for a 40% reduction. Febrile neutropenia occurred in 39.5% of control patients and 22.45% of G-CSF patients for a 46% reduction. Ten of the 17 studies had information on relative dose-intensity. The average relative dose-intensity was 86.7% in the control group and 95.1% in the G-CSF group. The main side effects of G-CSF were muscle and bone pain occurring in approximately 20% of patients.

Comments: These data document the benefits of prophylactic G-CSF in adult cancer patients receiving chemotherapy.

Reference:  Kuderer NM, Dale DC, Crawford J, et al. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: A systematic review. Journal of Clinical Oncology. 2007; 25:3158-3167.

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