Colony‐stimulating factor therapy and febrile neutropenia induced by chemotherapy: need for economical studies

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Febrile neutropenia is the major dose-limiting toxicity of anticancer chemotherapy in small cell lung cancer (SCLC). Nadir and duration of neutropenia have been correlated to the risk of developing sepsis [1], increasing healthcare costs and deteriorating quality of life. Despite empirical broad-spectrum antibiotic therapy at the onset of fever and dose reduction of chemotherapy during subsequent cycles, neutropenia-induced mortality remains important, particularly in patients with extensive SCLC. Multivariate analysis has shown that neutrophil recovery is a favourable prognostic factor in febrile neutropenia, independent of the use of antibiotic therapy [2]. The capacities of haematopoietic colony-stimulating factors (CSFs) to accelerate granular neutrophil recovery, as well as monocyte and eosinophil with granulocyte-macrophage CSFs (GM-CSFs), allows the hope of a reduction of haematological toxicity or an increased chemotherapy dose intensity. Primary prophylactic administration of granulocyte CSFs (G-CSFs), before the onset of neutropenia, reduced incidence of febrile neutropenia, length of hospitalization and antibiotic use subsequent to high-dose chemotherapy in SCLC patients [3, 4], whereas infectious mortality rate, response and survival rates were not improved. However, the cost-effectiveness of primary GCSF administration still remains controversial, with a high cost counterbalancing these benefits. G-CSF therapy combined with antibiotic therapy, in