FROM THE JOURNAL OF CLINICAL ONCOLOGY
Hematopoietic colony-stimulating factors should now be considered for patients who are over age 64 years, have diffuse aggressive lymphoma, and are receiving curative chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab), particularly those who have comorbidities.
This is one of several recommendations noted in the American Society of Clinical Oncology’s updated practice guidelines, published online in the Journal of Clinical Oncology, on the use of hematopoietic colony-stimulating factors (CSFs) to prevent or treat neutropenia and its complications in adults and children receiving chemotherapy.
This “moderately strong” recommendation is based on a single randomized clinical trial that found pegfilgrastim significantly reduced the risk of febrile neutropenia in this patient population, according to the guidelines (J. Clin. Oncol. 2015 July 13 [doi:10.1200/JCO.2015.62.3488]).
The updated guideline incorporates new evidence from 66 randomized controlled trials and meta-analyses published since its last update in 2006, said cochair Dr. Thomas J. Smith of the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, and his associates on the update committee.
In addition to pegfilgrastim and filgrastim, the guideline now addresses the use of tbo-filgrastim, filgrastim-sndz, and other biosimilars as they become available. These new agents are effective at preventing chemotherapy-related febrile neutropenia, so the choice of agent depends on convenience, cost, and clinical factors, and in some cases may be dictated by the patient’s treatment schedule. Certain off-label uses of pegfilgrastim can now be considered, such as giving it on the same day as chemotherapy if that is the only feasible timing for some patients.
CSFs should only be used to enable dose-dense chemotherapy regimens “if supported by convincing efficacy data or within an appropriately designed clinical trial” – for example, to support treatment of urothelial cancer or high-risk breast cancer targeted with high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin.
In contrast, the use of CSFs to enable dose-dense chemotherapy for Hodgkin lymphoma is not recommended at this time because the current data supporting such use are limited and conflicting. Similarly, the current evidence strongly argues against giving CSFs to enable dose-dense chemotherapy for other lymphomas, lung cancer, ovarian cancer, osteosarcoma, or sarcoma.
The guideline update was supported by the American Society of Clinical Oncology. Dr. Smith reported stock or other ownership in United Healthcare; his associates reported ties to numerous industry sources.
The full guideline and supplementary material, including slide sets and clinical tools, are available at www.asco.org/guidelines/wbcgf.
tor@frontlinemedcom.com
