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Hematological Toxicity in Lung Cancer

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Advances in Radiation Oncology in Lung Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

The toxicity of tumor cells after chemotherapy (Ch) and radiotherapy (RT), administered alone or in combination, is dose dependent. Aggression to the bone marrow, which is expressed by a reduction in circulating blood cells, is often the main dose-limiting toxicity in the treatment of lung cancer due to the risks of anemia, bleeding, and infection.

Prophylactic treatment with granulocyte colony-stimulating factors (G-CSF) or biosimilars is available to reduce the risk of Ch-induced neutropenia/febrile neutropenia.

The American Society of Clinical Oncology (ASCO) made recommendations (level of evidence II) on the treatment of anemia with erythropoiesis-stimulating agents (ESA). For patients with Ch-induced anemia, the committee recommended starting ESA when hemoglobin (Hb) approaches 10 g/dL, to increase the Hb level and decrease transfusions. A recent phase III study demonstrated the definitive positive impact of darbepoetin r-HuEPO (DARB). DARB was not inferior to placebo for OS and PFS and was superior to placebo for transfusion for Hb ≤8.0 g/dL.

In the last decade, systemic therapy for stage IV NSCLC has been selected for the presence of specific biomarkers. All of these patients should undergo molecular testing for programmed death ligand 1 (PD-L1) protein expression and mutations. The hematologic toxicity of these molecules is considered a rare toxicity (frequency <1%) but can be very significant.

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Authors and Affiliations

  1. Thoracic Unit, Radiation Oncology Department, Hospital Clínic i Universitari, Barcelona, Spain

    Francesc Casas & Meritxell Mollà

  2. Radiation Oncology Department, Hospital Clínic i Universitari, Barcelona, Spain

    Diego Muñoz-Guglielmetti, Gabriela Oses & Carla Cases

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  1. Francesc Casas
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  2. Diego Muñoz-Guglielmetti
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  3. Gabriela Oses
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  5. Meritxell Mollà
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Correspondence to Francesc Casas .

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  1. School of Medicine, University of Kragujevac, Kragujevac, Serbia

    Branislav Jeremić

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Casas, F., Muñoz-Guglielmetti, D., Oses, G., Cases, C., Mollà, M. (2022). Hematological Toxicity in Lung Cancer. In: Jeremić, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2022_335

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