From the Guidelines
Chemotherapy-induced neutropenia (CIN) is a life-threatening side effect of cancer treatment that requires prompt and effective management to prevent infection, reduce morbidity, and improve quality of life and survival rates. CIN is characterized by a significant drop in neutrophil count, typically below 1,500 cells/mm³, leaving patients vulnerable to bacterial and fungal infections. According to the guidelines of the National Comprehensive Cancer Network 1, the prophylactic use of myeloid growth factors, such as colony-stimulating factors (CSFs), can reduce the risk of CIN and its complications, including febrile neutropenia and infection-related mortality.
The importance of treating CIN cannot be overstated, as it is associated with substantial morbidity, mortality, and cost 1. The use of CSFs has been shown to reduce the incidence, duration, and severity of CIN and febrile neutropenia, allowing chemotherapy to continue on schedule without dose reductions and potentially improving disease control and survival in responsive and potentially curable malignancies. The routine prophylactic use of CSFs is recommended in patients at high risk (>20%) of developing febrile neutropenia or related complications that may compromise treatment 1.
Management of CIN typically includes the use of granulocyte colony-stimulating factors (G-CSFs) such as filgrastim (Neupogen), pegfilgrastim (Neulasta), or biosimilars, which stimulate the bone marrow to produce more neutrophils. These medications are usually administered as subcutaneous injections starting 24-72 hours after chemotherapy completion. For severe neutropenia (neutrophil count below 500 cells/mm³), patients may require prophylactic antibiotics, strict infection precautions, and possibly hospitalization. Prompt treatment reduces infection risk, decreases hospitalization rates, and ultimately improves cancer treatment outcomes and survival rates. Patients should monitor for fever (temperature above 100.4°F or 38°C), which requires immediate medical attention as it may indicate a serious infection requiring urgent antibiotic therapy.
From the FDA Drug Label
NEUPOGEN is indicated to decrease the incidence of infection‚ as manifested by febrile neutropenia‚ in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever A transient increase in neutrophil count is typically seen 1 to 2 days after initiation of NEUPOGEN therapy. Therefore, to ensure a sustained therapeutic response‚ administer NEUPOGEN daily for up to 2 weeks or until the ANC has reached 10‚000/mm3 following the expected chemotherapy-induced neutrophil nadir
Chemotherapy-induced neutropenia (CIN) is a condition where chemotherapy causes a significant decrease in neutrophil count, leading to an increased risk of infection. Treatment for CIN is important because it helps to decrease the incidence of infection and reduce the duration of neutropenia, thereby reducing the risk of complications and improving patient outcomes 2.
From the Research
Definition and Importance of Chemotherapy-Induced Neutropenia (CIN)
- Chemotherapy-induced neutropenia (CIN) is a frequent complication of chemotherapy associated with life-threatening infections, hospitalisation, and chemotherapy dose reductions and delays 3.
- CIN is one of the most common side effects seen in cancer patients, and it is deemed undesirable since it often constitutes a dose-limiting toxicity for cytotoxic agents leading to treatment delays and/or dose reductions 4.
- Neutropenia is commonly accompanied by a decrease in other hematopoietic lineages (anemia and/or thrombocytopenia) 4.
Treatment and Prevention of CIN
- Primary prophylaxis with granulocyte colony-stimulating factors (G-CSFs) has been shown to reduce the incidence and duration of neutropenia, febrile neutropenia, infections, hospitalisation, and antibiotic use 3.
- G-CSFs, such as filgrastim and pegfilgrastim, are used in practice to prevent and treat episodes of neutropenia 5.
- Pegfilgrastim is at least as effective as filgrastim in the prophylaxis of chemotherapy-induced neutropenia and has improved pharmacokinetics requiring reduced administration 3.
- Balugrastim, a novel long-acting recombinant G-CSF, has been shown to be noninferior to pegfilgrastim in reducing the mean duration of severe neutropenia during cycle 1 6.
Importance of Treatment for CIN
- Treatment for CIN is important to reduce the risk of life-threatening infections, hospitalisation, and chemotherapy dose reductions and delays 3, 4.
- CIN can be a surrogate marker of response and/or survival in patients treated with cytotoxic regimens, and chemotherapy doses may need to be escalated to achieve neutropenia 4.
- The addition of growth factor support and alternative dosing schemes may be strategies to consider instead of reducing treatment doses for safety concerns 4.