Chemotherapy dose intensity facilitated by use of lenograstim--implications for quality of life and survival.
Increasingly more aggressive chemotherapeutic regimens are being used in pursuit of better tumour response and patient survival. Studies in advanced breast cancer, small cell lung cancer (SCLC), urothelial cancer and sarcoma indicate that recombinant human granulocyte colony stimulating factor (rHuG-CSF) (lenograstim) facilitates modest dose intensification (20-30%), but at high intensity doses, chemotherapy-related toxicity remains a problem. Survival outcome in SCLC patients is still uncertain although in one randomised trial lenograstim facilitated a 20% increase in chemotherapy dosage which resulted in a 25% increase in complete remissions. In studies of breast cancer, an initially improved response rate was not maintained. However, increased dose intensity of chemotherapeutic agents in aggressive lymphoma was possible using lenograstim. Studies to date with haematopoietic growth factors have not been designed to specifically address the issue of survival and/or quality of life, although they have inferred that this is possible through dose intensification. The use of haematopoietic growth factors will allow the design of such studies, but a modest chemotherapy dose increase may be insufficient to improve survival. The future for dose intensification in cancer therapy may lie in the use of lenograstim-primed peripheral blood progenitor cells (PBPC) transplants to enhance haematopoietic recovery after high-dose sequential or myeloablative chemotherapy.
Gisselbrecht
C
C
Hôpital St Louis, Paris, France.
D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D018288:Carcinoma, Small Cell / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D000078224:Lenograstim; D008175:Lung Neoplasms / Q000188:drug therapy; D009369:Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D011994:Recombinant Proteins / Q000627:therapeutic use; D015996:Survival Rate
D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000078224:Lenograstim