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Granulocyte colony-stimulating factor (G-CSF) patterns of use in cancer patients receiving myelosuppressive chemotherapy

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Abstract

Purpose

Febrile neutropenia (FN) is a common and serious complication of myelosuppressive chemotherapy. Guidelines recommend primary granulocyte colony-stimulating factors (G-CSF) prophylaxis (PPG) in patients with a high risk (HR, >20 %) of developing FN. We performed a retrospective analysis using a subset of the Medicare 5 % database to assess patterns of G-CSF use and FN occurrence among elderly cancer patients receiving myelosuppressive chemotherapy.

Methods

Chemotherapy courses for patients aged 65+ years were identified; only the first course was used for this analysis. Using clinical guidelines, chemotherapy regimens were classified as HR or intermediate risk (IR) for FN. The first administration of G-CSF was classified as either PPG (within the first 5 days of the first cycle), secondary prophylaxis, or reactive.

Results

Twelve thousand seven hundred seven courses across five tumor types were classified as having a HR or IR regimen. G-CSF was used in 24.5–73.8 % of patients receiving a HR FN regimen, with the highest use in breast cancer or NHL. Except for breast cancer (where PPG was used in 52.1 %), PPG was given in less than half of patients receiving a HR regimen. Depending on the tumor type, 4.8–22.6 % of patients with a HR regimen had a neutropenia-related hospitalization.

Conclusions

Guidelines recommend PPG with HR FN regimens and older age (>65 years), an important risk factor for developing severe neutropenic complications. However, our results show that in this elderly population, PPG was not routinely used (range 4.8–52.1 %) in patients receiving HR FN regimens. Careful attention to FN risk factors, including chemotherapy regimen and patient age, is needed when planning treatment strategies.

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Acknowledgments

The authors thank Adrine Chung (Chronic Disease Research Group) for project management. This study was supported by a research contract from Amgen Inc, Thousand Oaks, CA

Conflict of interest

CS and TJA are employed by the Chronic Disease Research Group. MRC, VMC, JHP, and RB are employed by and are shareholders of Amgen Inc. AHB reports no conflicts of interest.

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Authors and Affiliations

  1. Amgen Inc., One Amgen Center Drive, M/S 17-1-A, Thousand Oaks, CA, 91320, USA

    Mi Rim Choi, Victoria M. Chia, John H. Page & Richard Barron

  2. Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S-206, Minneapolis, MN, 55404, USA

    Craig A. Solid & Thomas J. Arneson

  3. Division of Hematology/Oncology/Transplantation, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA

    Anne H. Blaes

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  1. Mi Rim Choi
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  2. Craig A. Solid
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  3. Victoria M. Chia
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Correspondence to Victoria M. Chia.

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Choi, M.R., Solid, C.A., Chia, V.M. et al. Granulocyte colony-stimulating factor (G-CSF) patterns of use in cancer patients receiving myelosuppressive chemotherapy. Support Care Cancer 22, 1619–1628 (2014). https://doi.org/10.1007/s00520-014-2121-7

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  • DOI: https://doi.org/10.1007/s00520-014-2121-7

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