Canadian Supportive Care Recommendations for the Management of Neutropenia in Patients with Cancer

Abstract

Hematological toxicities of cancer chemotherapy are common and often limit the ability to provide treatment in a timely and dose-intensive manner. This may be of utmost importance in the adjuvant or curative intent settings. Such hematological toxicities may include febrile neutropenia, infections, fatigue and bleeding, which may lead to additional complications and prolonged hospitalization. The older cancer patient and those with significant comorbidities may be at highest risk of neutropenic complications. Colony-stimulating factors (CSFs), such as filgrastim and pegfilgrastim can effectively attenuate much of the neutropenic consequences of chemotherapy, improve the ability to continue chemotherapy on a planned schedule and minimize the risk of febrile neutropenia, infectious morbidity and mortality. In this consensus statement, the use of CSFs in the management of neutropenia in patients with cancer is reviewed with specific recommendations based on published international guidelines tailored to the specifics of the Canadian practice landscape. We review the existing international guidelines, the indications for primary and secondary prophylaxis, the importance of maintaining dose intensity, and use of CSFs in leukemia, stem cell transplantation and in radiotherapy. We provide specific disease related recommendations in breast cancer, non-Hodgkin’s lymphoma, lung cancer and gastrointestinal cancer. Finally, we examine CSF dosing and schedules, the duration of therapy, as well as the acute and potential chronic toxicities that may be associated with CSFs.