"This study confirms previous trials that have shown that G-CSF is effective at decreasing fever and infections with higher-risk chemotherapy treatments but failed to show any benefit with lower-risk regimens," said Dr. Gary Lyman, co-director of the Hutchinson Institute of Cancer Outcomes Research for the Fred Hutchinson Cancer Research Center. "The study also showed that older age was associated with increased risk of neutropenia-related hospitalization, however the health care community needs to study G-CSF further to better understand which patients on which chemotherapies can benefit most."The group of patients treated with doxorubicin and cyclophosphamide and G-CSF actually showed more patients experiencing neutropenia than those not taking any G-CSF, however the difference was not significant, according to the study. However, hospitalizations occurred in 2 percent of patients with TC docetaxel and cyclophosphamide and G-CSF, and 7.1 percent with no G-CSF. For TCH carboplatin, docetaxel and trastuzumab regimens, neutropenia occurred in 1.3 percent of the patients with G-CSF and 7.1 percent with no G-CSF. Although G-CSF was associated with a lower rate of hospitalization in low to modest benefit in TC and TCH regimen, the value of G-CSF treatment in such regimens is less clear. For all regimens excluding high risk chemotherapy, about 48 patients would need to be treated at a total cost of more than $200,000 to prevent one more neutropenia related hospitalization compared to patients who did not receive G-CSF. "In spite of current guidelines and public campaign efforts about appropriate use of G-CSF prophylaxis, it is commonly used in chemotherapy regimens that do not have high risk for inducing neutropenia-related complications," said Dr. Debra Patt, vice president of Texas Oncology. "Our study found no benefit in one regimen, and even when low to modest benefit is observed, the value proposition for such wide spread use of G-CSF is limited. Future research that integrates HIT platforms, such as ASCO's CancerLinQ™, could refine the methods to identify patients for a targeted use of G-CSF."
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