title: Optimized granulocyte colony-stimulating factor prophylaxis in adult cancer patients: from biological principles to clinical guidelines.
abstract: BACKGROUND
  Chemotherapy-induced neutropenia, the depth and length of which are correlated to the risk of febrile neutropenia (FN) and neutropenia sepsis, remains a serious problem in medical oncology. Granulocyte colony-stimulating factors (G-CSF) stimulate the proliferation and survival of neutrophils and their precursors, thereby reducing the incidence, duration and severity of neutropenic events across a broad range of malignancies and regimens, often enabling the delivery of full chemotherapy dose intensity.
  
  
  METHODS
  In this review, areas covered include the physiologic role of G-CSF in granulopoiesis, as well as a related biological model of bone marrow kinetics after chemotherapy. Information relating to the application of clinical guidelines for optimization of prophylaxis of FN in adult cancer patients was critically summarized. The literature and pharmacological data were obtained through an electronic search.
  
  
  CONCLUSIONS
  There are relevant physiological and clinical evidences for the use of G-CSF to prevent FN and to ameliorate the myelotoxicities of cancer chemotherapy. In particular, biological models are in favor of the prophylactic rather than therapeutic use of G-CSF therapy. Use of a single dose of pegfilgrastim per cycle in appropriate patients provides a more convenient and potentially more effective strategy for assisting neutrophil recovery. While biosimilars may cost less, future developments in their regulation will need to address multiple issues. In the interim, physicians should remember that small differences in biochemical and biophysical characteristics might translate into differences in potency and immunogenic potential.
authors.affiliation: Cancer Institute Giovanni Paolo II, Medical and Experimental Oncology Unit, Viale Orazio Flacco, 65, 70124 Bari, Italy. n.silvestris@oncologico.bari.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Silvestris
authors.forename: Marzia
authors.initials: M
authors.lastname: Del Re
authors.forename: Amalia
authors.initials: A
authors.lastname: Azzariti
authors.forename: Evaristo
authors.initials: E
authors.lastname: Maiello
authors.forename: Lucia
authors.initials: L
authors.lastname: Lombardi
authors.forename: Saverio
authors.initials: S
authors.lastname: Cinieri
authors.forename: Attilio
authors.initials: A
authors.lastname: Guarini
authors.forename: Anna Elisabetta
authors.initials: AE
authors.lastname: Brunetti
authors.forename: Sabina
authors.initials: S
authors.lastname: Delcuratolo
authors.forename: Fernando
authors.initials: F
authors.lastname: De Vita
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pisconti
authors.forename: Romano
authors.initials: R
authors.lastname: Danesi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colucci
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D019891:Leukopoiesis / Q000502:physiology; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D017410:Practice Guidelines as Topic
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor