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. 2021 Apr;29(4):2179-2186.
doi: 10.1007/s00520-020-05715-3. Epub 2020 Sep 3.

Risk of chemotherapy-induced febrile neutropenia in patients with metastatic cancer not receiving granulocyte colony-stimulating factor prophylaxis in US clinical practice

Ahuva Averin  1 , Amanda Silvia  1 , Lois Lamerato  2 , Kathryn Richert-Boe  3 , Manpreet Kaur  2 , Devi Sundaresan  4 , Neel Shah  5 , Mark Hatfield  5 , Tatiana Lawrence  5 , Gary H Lyman  6 , Derek Weycker  7
Affiliations

Risk of chemotherapy-induced febrile neutropenia in patients with metastatic cancer not receiving granulocyte colony-stimulating factor prophylaxis in US clinical practice

Ahuva Averin et al. Support Care Cancer. 2021 Apr.

Abstract

Objectives: To evaluate the use of granulocyte colony-stimulating factor (G-CSF) prophylaxis in US patients with selected metastatic cancers and chemotherapy-induced febrile neutropenia (FN) incidence and associated outcomes among the subgroup who did not receive prophylaxis.

Methods: This retrospective cohort study was conducted at four US health systems and included adults with metastatic cancer (breast, colorectal, lung, non-Hodgkin lymphoma [NHL]) who received myelosuppressive chemotherapy (2009-2017). Patients were stratified by FN risk level based on risk factors and chemotherapy (low/unclassified risk, intermediate risk without any risk factors, intermediate risk with ≥ 1 risk factor [IR + 1], high risk [HR]). G-CSF use was evaluated among all patients stratified by FN risk, and FN/FN-related outcomes were evaluated among patients who did not receive first-cycle G-CSF prophylaxis.

Results: Among 1457 metastatic cancer patients, 20.5% and 28.1% were classified as HR and IR + 1, respectively. First-cycle G-CSF prophylaxis use was 48.5% among HR patients and 13.9% among IR + 1 patients. In the subgroup not receiving first-cycle G-CSF prophylaxis, FN incidence in cycle 1 was 7.8% for HR patients and 4.8% for IR + 1 patients; during the course, corresponding values were 16.9% and 15.9%. Most (> 90%) FN episodes required hospitalization, and mortality risk ranged from 7.1 to 26.9% across subgroups.

Conclusion: In this retrospective study, the majority of metastatic cancer chemotherapy patients for whom G-CSF prophylaxis is recommended did not receive it; FN incidence in this subgroup was notably high. Patients with elevated FN risk should be carefully identified and managed to ensure appropriate use of supportive care.

Keywords: Breast cancer; Colorectal cancer; Febrile neutropenia; Granulocyte colony-stimulating factor; Lung cancer; Non-Hodgkin lymphoma.

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Conflict of interest statement

AA is employed by Policy Analysis Inc., which received funding for this research from Amgen Inc.

AS is employed by Policy Analysis Inc., which received funding for this research from Amgen Inc.

LL reports grants from Policy Analysis Inc.

KR-B is employed by Kaiser Permanente Northwest Region, Portland, OR, which received study funding from Amgen Inc.

MK has nothing to disclose.

DS has nothing to disclose.

NS is an employee of and owns stock in Amgen.

MH is an employee of and owns stock in Amgen.

TL is an employee of and owns stock in Amgen.

GHL reports serving as a consultant for Agendia, Amgen, Genomic Health, Halozyme Therapeutics, Mylan, Partners HealthCare, Pfizer, Samsung Bioepis, and Spectrum Pharmaceuticals.

DW is employed by Policy Analysis Inc., which received funding for this research from Amgen Inc.

Figures

Fig. 1
Fig. 1
Prophylaxis with G-CSF in all patients with metastatic cancer and patients with metastatic breast cancer, colorectal cancer, lung cancer, and NHL in cycle 1 (a) and during the treatment coursea (b). FN, febrile neutropenia; G-CSF, granulocyte colony-stimulating factor; IR, intermediate FN risk level; LR, low FN risk level; NHL, non-Hodgkin lymphoma; UR, unclassified FN risk level. aReceipt in ≥ 1 cycle during the treatment course
Fig. 2
Fig. 2
Incidence of FN in patients who did not receive primary prophylactic G-CSF in cycle 1 (a) and during the treatment course (b) presented by metastatic breast cancer, colorectal cancer, lung cancer, and NHL. FN, febrile neutropenia; IR, intermediate FN risk level; LR, low FN risk level; NHL, non-Hodgkin lymphoma; UR, unclassified FN risk level
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