2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours
- Study type
- Clinical guideline
- Study name
- EORTC G-CSF 2010
- Design
- Clinical guideline based on a systematic literature review (update of the 2006 guideline of the EORTC European guidelines working party)
- Sample size
- Not applicable (clinical guideline); not stated in the abstract
- Source
- European Journal of Cancer · 2011
In plain words
Chemotherapy can lower the number of white blood cells (neutrophils) and raise the risk of an infection with fever; this sometimes leads to lower chemotherapy doses or delays. Medicines called G-CSF can be given to prevent this problem. This guideline explains when your doctor should consider using these medicines, based on the type of chemotherapy and your own characteristics (for example, being 65 or older, or having had a previous episode of fever with low neutrophils). The final decision about which medicine to use and when is up to your treating doctor.
Key points
Key guideline recommendations
- Level of evidence not stated in the abstract
Adverse patient-related risk factors, such as older age (≥65 years) and neutrophil count, should be evaluated in the overall assessment of febrile neutropenia (FN) risk before each cycle of chemotherapy.
- Level of evidence not stated in the abstract
After a previous episode of FN, patients should receive prophylactic G-CSF in subsequent cycles.
- Level of evidence not stated in the abstract
Prophylactic G-CSF remains recommended in patients receiving a chemotherapy regimen with a high risk of FN (≥20%).
- Level of evidence not stated in the abstract
When using a chemotherapy regimen with an FN risk of 10 to 20%, particular attention should be given to patient-related risk factors that may increase the overall risk of FN.
- Level of evidence not stated in the abstract
In situations where dose-dense or dose-intense chemotherapy strategies have survival benefits, prophylactic G-CSF support is recommended. If reductions in chemotherapy dose intensity or density are associated with a poor prognosis, primary G-CSF prophylaxis may be used to maintain chemotherapy.
- Level of evidence not stated in the abstract
Use of any of filgrastim, lenograstim and pegfilgrastim is recommended, where indicated, to prevent FN and its related complications. The choice of formulation depends on individual clinical judgement.
Study population
Adult cancer patients at risk of chemotherapy-induced febrile neutropenia (FN), including patients with lymphoproliferative disorders and solid tumours.
Endpoints
Aim of the guideline: to reduce the incidence of chemotherapy-induced febrile neutropenia and its related complications through the use of G-CSFs (filgrastim, including approved biosimilars, lenograstim and pegfilgrastim).
Safety and side effects
The abstract does not report safety information (rates of grade ≥3 adverse events). Details are available in the full text of the guideline.
Clinical significance and place in guidelines
This guideline recommends assessing the risk of febrile neutropenia before each cycle of chemotherapy (taking into account factors such as age ≥65 years and neutrophil count) and recommends prophylactic G-CSF for regimens with a high risk of FN (≥20%), after a previous episode of FN and in dose-dense or dose-intense strategies that have a survival benefit. Filgrastim, lenograstim and pegfilgrastim are all suitable options, and the choice between them depends on clinical judgement. The current status of this guideline and of newer versions from EORTC or other societies should be checked.
Limitations
The abstract refers to low-level evidence (audit and clinical practice data) on suboptimal use of daily G-CSFs. The grading of the recommendations and the full list of high-risk and intermediate-risk regimens are not given in the abstract; the full text should be consulted. This guideline was published in 2010 and may have been superseded by newer versions.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.