Chemotherapy-induced febrile neutropenia (FN) causes treatment delays and interruptions and can have fatal consequences. Current
guidelines provide recommendations on granulocyte colony-stimulating factors (G-CSF) for prevention of FN, but guidance is unclear regarding use of short- vs long-acting G-CSF (e.g., filgrastim vs pegfilgrastim/lipegfilgrastim, respectively). An international panel of experts convened to develop guidance on appropriate use of
pegfilgrastim for prevention of chemotherapy-induced FN.
Guidance recommendations were developed following a literature review, survey, evaluation of current practice, and an expert meeting.
Consensus was established using an anonymous Delphi-based approach.
Guidance recommendations for prevention of treatment-associated FN were as follows: for treatment with curative intent, maintenance of dose intensity using G-CSF to prevent dose delays/reduction should be standard of care; for treatment-associated FN risk ≥ 20%, short-acting G-CSF/pegfilgrastim should be given from cycle 1 onwards; and for treatment-associated FN risk < 20%, short-acting G-CSF/pegfilgrastim should be given if factors suggest overall risk (including treatment-related and patient-related risk factors) is ≥ 20%. It was agreed that
pegfilgrastim and 11 days\' filgrastim have similar efficacy and safety and that
pegfilgrastim is preferred to < 11 days\' filgrastim (and may be preferred to ≥ 11 days\' filgrastim based on adherence and convenience); pegfilgrastim is not appropriate in weekly chemotherapy; in split-dose chemotherapy, pegfilgrastim is recommended 24 h after last chemotherapy dose; and during palliative chemotherapy, patient adherence and convenience may favor pegfilgrastim.
In this era of targeted therapies, additional trials with G-CSF are still required. These recommendations should be used with existing
guidelines to optimize
pegfilgrastim use in clinical practice.