Summary and Comparison of Myeloid Growth Factor Guidelines in Patients Receiving Cancer Chemotherapy
Chemotherapy-induced neutropenia and its complications are major dose-limiting toxicities of cancer chemotherapy. The myeloid growth factors have been shown to reduce the risk of neutropenic events across malignancies, regimens, and associated risk categories often enabling the delivery of greater chemotherapy dose intensity. Three different practice guidelines for the myeloid growth factors have recently been published by major professional organizations. A comprehensive review and comparison of the guidelines using a priori structured content criteria and a previously validated quality appraisal tool are reported. Consistency in the final recommendations from these guidelines is observed for primary prophylaxis with the colony-stimulating factors (CSFs) when the risk of febrile neutropenia is in the range of 20% or greater. There is also consistency in the recommendation that patients receiving regimens associated with lower risk should have CSF use guided by individual risk assessment. Critical quality appraisal indicates that the scope and purpose, stakeholder involvement, and applicability of the guidelines differ little. There is more emphasis on comprehensive literature reviews in the ASCO and EORTC guidelines while the NCCN guidelines are more current based on systematic annual updates. The clarity of presentation also favors the NCCN guidelines with recommendations generally presented as both text and algorithmic diagram. All three new or updated guidelines recommend prophylactic use of the myeloid growth factors in patients at greater than a 20% risk of febrile neutropenia and in those with important factors increasing individual risk of neutropenic complications.
KeywordsSummary Comparison Myeloid Growth Factor Guidelines chemotherapy
- 8.Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet 2005;365:1687–1717.Google Scholar
- 10.Bonneterre J, Roche H, Kerbrat P, et al. Epirubicin increases long-term survival in adjuvant chemotherapy of patients with poor-prognosis, node-positive, early breast cancer: 10-year follow-up results of the French Adjuvant Study Group 05 randomized trial. J Clin Oncol. 2005;23:2686–93.CrossRefPubMedGoogle Scholar
- 11.Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol. 2003;21:1431–9.CrossRefPubMedGoogle Scholar
- 14.Chu E, DeVita V. Principles of medical oncology. In: DeVita VT, Rosenberg SA, editors. Cancer: principles and practice of oncology. 7th ed. Philadelphia, PA: Lippincott; 2006. pp. 295–306.Google Scholar
- 19.Timmer-Bonte JN, de Boo TM, Smit HJ, et al. Prevention of chemotherapy-induced febrile neutropenia by prophylactic antibiotics plus or minus granulocyte colony-stimulating factor in small-cell lung cancer: a Dutch randomized phase III study. J Clin Oncol. 2005;23:7974–84.CrossRefPubMedGoogle Scholar
- 21.Kuderer NM, Crawford J, Dale DC, Lyman GH. Meta-analysis of prophylactic granulocyte colony-stimulating factor (G-CSF) in cancer patients receiving chemotherapy. J Clin Oncol. 2005;23:758 s. Abstract 8117.Google Scholar
- 25.Lyman GH, Kuderer NM. Economics of hematopoietic growth factors. In: Morstyn G, Foote M, Lieschke GJ, editors. Cancer drug discovery and development. Hematopoietic growth factors in oncology: basic science and clinical therapeutics. Totowa, NJ: Humana Press Inc; 2004. pp. 409–443.Google Scholar
- 27.American Society of Clinical Oncology. Recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. J Clin Oncol. 1994;12(11):2471–508.Google Scholar
- 28.Ozer H, Armitage JO, Bennett CL, et al. Update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol. 2000;2000(18):3558–85.Google Scholar
- 31.Crawford J, Althaus B, Armitage J, Blayney DW, Cataland S, Dale DC, Demetri GD, Foran J, Heaney ML, Htoy S, Kloth DD, Lyman GH, Michaud L, Motl S, Vadham-Raj S, Wong MK. Myeloid growth factors. 2006. http://www.nccn.org/professionals/physician_gls/PDF/myeloid_growth.pdf.
- 32.Aapro MS, Cameron DA, Pettengell R, et al. European Organisation for Research and Treatment of Cancer (EORTC) Granulocyte Colony-Stimulating Factor (G-CSF) Guidelines Taskforce. EORTC guidelines for the use of granulocyte colony-stimulating factor in adult patients with chemotherapy-induced febrile neutropenia. Eur J Cancer 2006;42: 2433–53.Google Scholar
- 34.The AGREE Collaboration. Appraisal of the Guidelines for Research and Evaluation (AGREE) Instrument. http://www.agreecollaboraiton.org.