Smith Thomas J, Hillner Bruce E
From the Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Hillner Consulting, LLC, Richmond, VA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA.
Am Soc Clin Oncol Educ Book. 2016;35:e524-7. doi: 10.1200/EDBK_156062.
We present the 2015 American Society of Clinical Oncology (ASCO) white cell growth factors, or colony-stimulating factor (CSF), guidelines, updated from 2006. One new indication has been added-dose-intense chemotherapy for bladder cancer-to accompany the existing use for dose-dense breast cancer chemotherapy. Colony-stimulating factors remain appropriate for any regimen where the risk of febrile neutropenia is about 20% per cycle and dose reduction is not appropriate. Based on new evidence from multiple trials, CSF use is no longer indicated in treatment of lymphoma unless there are special risk factors. The United States accounts for 78% of the sales of CSF. The panel approved the use of all biosimilars, but the cost savings will be small as the price is about 80% of the branded CSFs. More biosimilars at lower cost are awaited. Methods to reduce use without harm to patients, by requiring justification according to accepted guidelines, are ongoing.
我们展示了2015年美国临床肿瘤学会（ASCO）白细胞生长因子或集落刺激因子（CSF）指南，该指南是对2006年版指南的更新。新增了一项适应证——用于膀胱癌的剂量密集化疗，以补充现有的用于剂量密集型乳腺癌化疗的用途。对于任何发热性中性粒细胞减少风险约为每周期20%且不适合降低剂量的方案，集落刺激因子仍然适用。基于多项试验的新证据，除非存在特殊风险因素，否则CSF不再用于淋巴瘤治疗。美国占CSF销售额的78%。该小组批准了所有生物类似药的使用，但由于价格约为品牌CSF的80%，成本节约幅度较小。人们期待有更多成本更低的生物类似药。通过要求根据公认指南进行用药合理性论证，在不损害患者的情况下减少用药的方法正在推进。
