title: The use of granulocyte colony stimulating factor (G-CSF) and management of chemotherapy delivery during adjuvant treatment for early-stage breast cancer--further observations from the IMPACT solid study.
abstract: OBJECTIVE
  To investigate the use and impact of granulocyte colony-stimulating factors (G-CSF) on chemotherapy delivery and neutropenia management in breast cancer in a clinical practice setting.
  
  
  METHODS
  IMPACT Solid was an international, prospective observational study in patients with a physician-assessed febrile neutropenia (FN) risk of ≥20%. This analysis focused on stages I-III breast cancer patients who received a standard chemotherapy regimen for which the FN risk was published. Chemotherapy delivery and neutropenia-related outcomes were reported according to the FN risk of the regimen and intent of G-CSF use.
  
  
  RESULTS
  690 patients received a standard chemotherapy regimen; 483 received the textbook dose/schedule with a majority of these regimens (84%) having a FN risk ≥10%. Patients receiving a regimen with a FN risk ≥10% were younger with better performance status than those receiving a regimen with a FN risk <10%. Patients who received higher-risk regimens were more likely to receive G-CSF primary prophylaxis (48% vs 22%), complete their planned chemotherapy (97% vs 88%) and achieve relative dose intensity ≥85% (93% vs 86%) than those receiving lower-risk regimens. Most first FN events (56%) occurred in cycles not supported with G-CSF primary prophylaxis.
  
  
  CONCLUSIONS
  Physicians generally recommend standard adjuvant chemotherapy regimens and were more likely to follow G-CSF guidelines for younger, good performance status patients in the curative setting, and often modify standard regimens in more compromised patients. However, G-CSF support is not optimal, indicated by G-CSF primary prophylaxis use in <50% of high-risk patients and observation of FN without G-CSF support.
authors.affiliation: University of Tampere, Tampere University Hospital, Tampere, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Mäenpää
authors.affiliation: Chania General Hospital, Chania, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Varthalitis
authors.affiliation: Orbis Medisch Centrum, Sittard, Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Erdkamp
authors.affiliation: Brust-Zentrum Zürich, Zürich, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Trojan
authors.affiliation: Oncology Clinic, Jagiellonian University, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Krzemieniecki
authors.affiliation: Akademiska Hospital, Uppsala, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Lindman
authors.affiliation: Amgen Ltd, Uxbridge, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Bendall
authors.affiliation: Amgen Inc, Thousand Oaks, CA, USA.
authors.forename: Florian D
authors.initials: FD
authors.lastname: Vogl
authors.affiliation: Ottawa Regional Cancer Centre, Ottawa, Canada. Electronic address: sverma@Ottawahospital.on.ca.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Verma
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D016179:Granulocyte Colony-Stimulating Factor
keywords: Chemotherapy delivery; Clinical practice; Granulocyte colony-stimulating factor; Neutropenia