Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo, 121, 1000, Brussels, Belgium.
Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo, 121, 1000, Brussels, Belgium.
Crit Rev Oncol Hematol. 2017 Dec;120:163-179. doi: 10.1016/j.critrevonc.2017.11.005. Epub 2017 Nov 11.
Despite the overwhelming evidence for the role of granulocyte colony stimulating factors (G-CSF) in managing febrile neutropenia (FN) risk, chemotherapy-induced neutropenia (CIN) and/or FN still remain the most common reasons for reducing relative dose intensity (RDI) and/or delaying chemotherapy schedule. The need to maintain RDI to ensure optimal clinical outcomes is one of the key rationales for utilizing G-CSF. There is a high incidence of reduced RDI in both curative and palliative settings, and this observation is especially evidenced in retrospective analyses. Reduced RDI leads to significantly decreased survival outcomes and quality of life in various malignancies at various clinical settings and stages. Beyond its role as a surrogate prognostic marker, high-grade CIN may have an unexpected predictive role in clinical practice, as illustrated by several data relating CIN occurrence with favorable survival outcomes; this may be due to the fact that body surface area (BSA) - based calculation of dose may not fully account for the pharmacokinetics (PK) of cytotoxic drugs and the fact that there may be variability in drug metabolism between patients treated with same chemotherapy regimens.
尽管粒细胞集落刺激因子（G-CSF）在管理发热性中性粒细胞减少症（FN）风险、化疗引起的中性粒细胞减少症（CIN）和/或 FN 方面的作用已得到充分证实，但 CIN 和/或 FN 仍然是降低相对剂量强度（RDI）和/或延迟化疗方案的最常见原因。为了确保最佳的临床结果，需要维持 RDI，这是使用 G-CSF 的一个关键理由。在治疗和姑息治疗环境中，RDI 降低的发生率都很高，这一观察结果在回顾性分析中尤为明显。在各种临床环境和阶段的各种恶性肿瘤中，RDI 降低会导致生存率和生活质量显著下降。除了作为替代预后标志物的作用外，高等级 CIN 在临床实践中可能具有意外的预测作用，因为有几项数据表明 CIN 的发生与有利的生存结果相关；这可能是因为基于体表面积（BSA）的剂量计算可能无法完全反映细胞毒性药物的药代动力学（PK），并且接受相同化疗方案治疗的患者之间可能存在药物代谢的差异。
