Grossi Francesco, Tiseo Marcello
Division of Medical Oncology A, Disease Management Team-Lung Cancer, National Institute for Cancer Research, L. go R. Benzi 10, 16132 Genova, Italy.
Crit Rev Oncol Hematol. 2006 Jun;58(3):221-30. doi: 10.1016/j.critrevonc.2005.09.002. Epub 2006 May 11.
Neutropenia and subsequent infections are common events that limit treatment of non-small cell lung cancer (NSCLC). Granulocyte growth factors (G- and GM-CSF) have been introduced in clinical practice and their use has yielded a reduction of the infection risk related to chemotherapy and a dose increase of drug delivery. Randomized clinical trials have shown that granulocyte colony-stimulating factors and, more recently, the longer-acting pegylated granulocyte colony-stimulating factor (pegfilgrastim) effectively reduce the incidence and severity of neutropenia and of its complications. Recommendations for the use of haematopoietic colony-stimulating factors from the American Society of Clinical Oncology (ASCO) have been published in 1994 and updated in 1996, 1997 and 2000. Recently, moreover, National Comprehensive Cancer Network (NCCN) guidelines for the myeloid growth factors in cancer treatment make available. Chemotherapy-associated myelosuppression is a major limitation of anticancer therapy also in early stage, local advanced and metastatic NSCLC. Recently, dose-dense chemotherapy has been shown to improve the outcome in early stage breast cancer and non-Hodgkin's lymphoma. However, few randomized trials have been reported on chemotherapy with or without granulocyte growth factors as primary prophylaxis in NSCLC. Presently, there is no evidence for a benefit in response rate and survival from the use of granulocyte growth factors as support of chemotherapy, in particular, for locally advanced and metastatic NSCLC. In clinical practice, the role of granulocyte growth factors for NSCLC treatment should be limited following the guidelines. An appropriate use of granulocyte growth factors may reduce the overall cost of treatment and improve the quality of life, important aims in the treatment of patients with local advanced or metastatic NSCLC. In the future, we need to identify patients who can benefit from granulocyte growth factors for optimize the schedule and doses, in advanced disease and also, after the recent positive results of adjuvant chemotherapy, in early stages. This review summarizes the present knowledge on the use of granulocyte growth factors in NSCLC.
中性粒细胞减少症及随后发生的感染是限制非小细胞肺癌（NSCLC）治疗的常见事件。粒细胞生长因子（G-和GM-CSF）已被引入临床实践，其使用降低了与化疗相关的感染风险，并增加了药物递送剂量。随机临床试验表明，粒细胞集落刺激因子以及最近作用时间更长的聚乙二醇化粒细胞集落刺激因子（培非格司亭）可有效降低中性粒细胞减少症及其并发症的发生率和严重程度。美国临床肿瘤学会（ASCO）关于使用造血集落刺激因子的建议于1994年发布，并于1996年、1997年和2000年进行了更新。此外，最近国家综合癌症网络（NCCN）发布了癌症治疗中髓系生长因子的指南。化疗相关的骨髓抑制也是早期、局部晚期和转移性NSCLC抗癌治疗的主要限制因素。最近，剂量密集化疗已被证明可改善早期乳腺癌和非霍奇金淋巴瘤的治疗结果。然而，关于在NSCLC中使用或不使用粒细胞生长因子作为主要预防措施的化疗，报道的随机试验很少。目前，没有证据表明使用粒细胞生长因子作为化疗支持能提高缓解率和生存率，特别是对于局部晚期和转移性NSCLC。在临床实践中，应遵循指南限制粒细胞生长因子在NSCLC治疗中的作用。合理使用粒细胞生长因子可能会降低总体治疗成本并提高生活质量，这是局部晚期或转移性NSCLC患者治疗中的重要目标。未来，我们需要确定哪些患者可从粒细胞生长因子中获益，以便在晚期疾病中优化给药方案和剂量，并且在辅助化疗近期取得阳性结果后，也在早期阶段进行优化。本综述总结了目前关于粒细胞生长因子在NSCLC中应用的知识。
