ISY-23-2 - The vision of Japanese guidelines for the proper use of G-CSF and future perspective

Abstract

The Japanese guidelines for the proper use of G-CSF were drastically revised in 2013, in which primary prophylactic use of G-CSF was recommended for the prevention of febrile neutropenia (FN) in cancer patients treated with chemotherapy when the risk of FN is 20% or higher. However, in most solid tumors, prophylactic use of G-CSF had not been covered by health insurance until pegfilgrastim was approved in Japan in 2014. Before the approval of pegfilgrastim, we could not use G-CSFs in line with guidelines and could not use many global standard chemotherapy regimens such as TAC (docetaxel + doxorubicin + cyclophosphamide) and dose-dense AC (doxorubicin + cyclophosphamide) followed by dose-dense paclitaxel as adjuvant or neo-adjuvant chemotherapy for breast cancer.Now, we can use prophylactic G-CSF and global standard chemotherapy. We should promote the appropriate use of G-CSF, ensure the safety in Japanese patients, and conduct well-designed clinical trials to provide evidence to answer clinical questions. The Japanese guidelines for the proper use of G-CSF were drastically revised in 2013, in which primary prophylactic use of G-CSF was recommended for the prevention of febrile neutropenia (FN) in cancer patients treated with chemotherapy when the risk of FN is 20% or higher. However, in most solid tumors, prophylactic use of G-CSF had not been covered by health insurance until pegfilgrastim was approved in Japan in 2014. Before the approval of pegfilgrastim, we could not use G-CSFs in line with guidelines and could not use many global standard chemotherapy regimens such as TAC (docetaxel + doxorubicin + cyclophosphamide) and dose-dense AC (doxorubicin + cyclophosphamide) followed by dose-dense paclitaxel as adjuvant or neo-adjuvant chemotherapy for breast cancer. Now, we can use prophylactic G-CSF and global standard chemotherapy. We should promote the appropriate use of G-CSF, ensure the safety in Japanese patients, and conduct well-designed clinical trials to provide evidence to answer clinical questions.