title: Real-World Conundrums and Biases in the Use of White Cell Growth Factors.
abstract: We present the 2015 American Society of Clinical Oncology (ASCO) white cell growth factors, or colony-stimulating factor (CSF), guidelines, updated from 2006. One new indication has been added-dose-intense chemotherapy for bladder cancer-to accompany the existing use for dose-dense breast cancer chemotherapy. Colony-stimulating factors remain appropriate for any regimen where the risk of febrile neutropenia is about 20% per cycle and dose reduction is not appropriate. Based on new evidence from multiple trials, CSF use is no longer indicated in treatment of lymphoma unless there are special risk factors. The United States accounts for 78% of the sales of CSF. The panel approved the use of all biosimilars, but the cost savings will be small as the price is about 80% of the branded CSFs. More biosimilars at lower cost are awaited. Methods to reduce use without harm to patients, by requiring justification according to accepted guidelines, are ongoing.
authors.affiliation: From the Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Hillner Consulting, LLC, Richmond, VA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.affiliation: From the Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Hillner Consulting, LLC, Richmond, VA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Hillner
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059451:Biosimilar Pharmaceuticals / Q000627:therapeutic use; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000473:pathology*; D003115:Colony-Stimulating Factors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D017408:Guidelines as Topic; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome; D014481:United States; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D059451:Biosimilar Pharmaceuticals; D003115:Colony-Stimulating Factors; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone