Rader Michael
Union State Bank Cancer Center, Nyack Hospital, Columbia University, Nyack, New York, USA.
Oncology (Williston Park). 2006 Apr;20(5 Suppl 4):16-21.
Neutropenia is the primary dose-limiting toxicity in patients treated with myelosuppressive chemotherapy, leading in some cases to substantial morbidity and early mortality, and disrupting treatment with potentially curative regimens. The use of granulocyte colony-stimulating factors (G-CSFs) such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), as primary prophylaxis starting in the first cycle of chemotherapy, has been shown to reduce the rates of febrile neutropenia (FN) and of FN-related hospitalization, as well as the use of intravenous anti-infectives. A recent meta-analysis has shown significantly lower infection-related mortality with the first-cycle use of G-CSFs. Both filgrastim and pegfilgrastim were originally approved on the basis of their effectiveness in patients treated with chemotherapy regimens that are associated with a 40% or greater risk of FN. Pegfilgrastim, which is given once per cycle, has been shown to reduce the risk of FN by 94% in breast cancer patients treated with docetaxel (Taxotere). In addition, a recent cost-minimization analysis has shown that first-cycle use of pegfilgrastim may be cost-neutral in patients in whom the predicted risk of FN is less than 20%. These findings have important implications for clinical guidelines for preventing chemotherapy-induced neutropenia and FN.
中性粒细胞减少是接受骨髓抑制性化疗患者的主要剂量限制性毒性反应，在某些情况下会导致严重发病和早期死亡，并干扰可能治愈性方案的治疗。使用粒细胞集落刺激因子（G-CSFs），如非格司亭（惠尔血）和培非格司亭（新瑞白），从化疗的第一个周期开始作为主要预防措施，已被证明可降低发热性中性粒细胞减少（FN）的发生率、FN相关住院率以及静脉抗感染药物的使用。最近的一项荟萃分析表明，在第一个周期使用G-CSFs可显著降低感染相关死亡率。非格司亭和培非格司亭最初都是基于它们在接受与FN风险40%或更高相关的化疗方案治疗的患者中的有效性而获批的。培非格司亭每周期给药一次，在接受多西他赛（泰索帝）治疗的乳腺癌患者中已被证明可将FN风险降低94%。此外，最近的一项成本最小化分析表明，在FN预测风险小于20%的患者中，第一个周期使用培非格司亭可能在成本上是中性的。这些发现对预防化疗引起的中性粒细胞减少和FN的临床指南具有重要意义。
