Cancer Chemotherapy, Neutropenia and the Use of Myeloid Growth Factors

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Cancer Chemotherapy, Neutropenia and the use of Myeloid Growth Factors

Dr. David E. Chase Pharm D

Intro about self and presentation

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Case Presentation- Ms. K
69 year old retired female executive who presents with chest pain and mild fatigue.
Exam  Bilateral cervical, axillary and inguinal adenopathy  PS-1 Labs Hgb 10.5g/dl  WBC 4200/mm³  ANC 2100/mm³  Platelet Count 120,000  Creatinine 1.2
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Case Presentation – Ms. K
CT Scan • Hilar and mediastinal adenopathy Cervical lymph node biopsy • Diffuse anaplastic lymphoma, stage III Treatment • R-CHOP chemotherapy every 3 weeks for 6 cycles (based on response)

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R-CHOP Ms. K. Therapy Options
Prior to starting R-CHOP, you discuss complications of chemotherapy-neutropenia
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Dose reduction of R-CHOP Standard dose of R-CHOP plus prophylactic antibiotics

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Standard dose of R-CHOP plus prophylactic CSF support
Standard dose of R-CHOP plus prophylactic CSF support and antibiotics Standard dose of R-CHOP alone and treat with antibiotics and CSF as needed if neutropenic complications develop

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What if we change diagnosis to small cell?

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Chemotherapy-induced neutropenia & its complications
Myelosuppressive chemotherapy
Neutropenia
Febrile neutropenia (FN) Chemotherapy dose delays and dose reductions

Complicated life-threatening infection and prolonged hospitalization Reduced survival

Decreased relative dose intensity (RDI)

Kuderer NM et al. Cancer 2006;106:2258-2266 Chirivella I et al. J Clin Oncol 2006;24:abstract 668 Bosly A et al. Ann Hematol 2008;87:277-283

So the problem with myelosuppressive chemotherapy

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Risk of FN increases with duration of severe neutropenia*
120
Predicted probability of FN (%) (temperature >38.2 C and ANC