The time for a new way to approach
neutropenia (CIN) is now
Recent guidelines suggest that the inevitability of chemotherapy toxicity and the effectiveness of granulocyte-colony stimulating factors (G-CSFs) deserve a second look from healthcare professionals.1
Unfortunately, it takes approximately 1-8 days for neutrophils to mature, leaving patients vulnerable to CIN and unprotected during the Neutropenia Vulnerability Gap.2,3
The key is to diagnose CIN early — before the onset of infection4
Managing CIN may be difficult but can be made considerably easier with an early and timely diagnosis of neutropenia — before an infection develops. Timely prevention can improve outcomes and better ensure scheduled chemotherapy-dose delivery. Otherwise, if early detection is missed, repeated infections are likely to occur and may lead to hospitalization, treatment delays, and dose reductions.4
Novel Approaches to CIN Prevention
are in Development
Today, the current standard of care for preventing CIN in intermediate- and high-risk patients has limitations. Current preventive therapies provide only a small reduction in infection-related mortality and leave patients vulnerable to infection, febrile neutropenia, and hospitalizations. But novel therapeutic approaches are on the horizon.5
Expert Perspectives in CIN
Dr. Lyman: The bottom line is we need to continue to treat cancer patients that are diagnosed every day. Many of them in the early stages, potentially curative stages of the disease. We’ve learned that we can’t just delay treatments or give them less effective treatments. We need to give them the optimal treatments…We need to do whatever we can to optimally support our patients through this treatment and continue to do this important research that would hopefully, ideally, at some point we’ll find a way to almost completely protect patients from neutropenic complications, febrile neutropenia, serious infections like this. Even post-COVID, those enhancements, those effective approaches to cancer treatment will go on to improve the outcomes of the patients with cancer that put their lives in our trust.
- National Comprehensive Cancer Network (NCCN Guidelines®). NCCN Clinical Practice Guidelines in Oncology. Hematopoietic growth factors (Version 2.2020). Accessed June 29, 2020. https://www.nccn.org/professionals/physician_gls/pdf/growthfactors.pdf
- Burris HA, Belani C, Kaufman PA, et al. Pegfilgrastim on the same day versus next day of chemotherapy in patients with breast cancer, non–small-cell lung cancer, ovarian cancer, and non-Hodgkin’s lymphoma: results of four multicenter, double-blind, randomized phase II studies. J Oncol Pract. 2010;6(3):133-140.
- Li Y, Klippel Z, Shih X, Wang H, Reiner M, Page JH. Trajectory of absolute neutrophil counts in patients treated with pegfilgrastim on the day of chemotherapy versus the day after chemotherapy. Cancer Chemother Pharmacol. 2016;77(4):703-712.
- Gupta A, Abbasi B, Gupta S. Management of chemotherapy induced neutropenia—an unmet clinical need. Am J Biomed Sci & Res. 2019;4(5):313-318.
- Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004;100(2):228-237.