Personalized medicine and cancer supportive care: appropriate use of colony-stimulating factor support of chemotherapy.
Personalized medicine and cancer supportive care: appropriate use of colony-stimulating factor support of chemotherapy.
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个性化医疗和癌症支持护理：适当使用化疗的集落刺激因子支持。
DOI：
10.1093/jnci/djr195
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
Lyman,GaryH
中科院分区：
文献类型：
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作者：
Kuderer,NicoleM;Lyman,GaryH
DOI：10.1093/jnci/djr 195 ©作者2011.牛津大学出版社出版。All rights reserved. Advance Access出版于2011年6月13日。如需订阅，请发送电子邮件至：期刊。permissions@ oup. com. jnci。牛津期刊。组织JNCI|社论911在整个化疗治疗期间仍然很高（9）。在化疗的第一个周期早期开始CSF并持续化疗方案的所有周期（一级预防）已被证明可显著降低FN的风险以及感染相关和早期全因死亡率，同时减少化疗剂量减少和延迟的需要（10，11）。此外，大多数CSF一级预防的关键性试验允许对照组中发生血小板减少事件后进行二级预防，这为一级预防上级二级预防提供了合理的证据（10）。来自实体瘤和淋巴瘤患者的随机对照试验（RCT）的关于CSF支持化疗改善总生存期的潜在价值的数据也越来越多（12）。来自美国临床肿瘤学会（ASCO）的CSF使用的临床实践指南（13），国家综合癌症网络（NCCN）（14），和欧洲癌症研究和治疗组织（EORTC）（11），沿着美国传染病协会（IDSA）（15）的指南，建议在FN风险为20%或更高的患者中考虑使用CSF进行一级预防。指南小组指出的FN的风险因素之一是RCT中报告的特定化疗方案，其通常被分类为FN的高风险（> 20%），中等风险（10%-20%）或低风险（< 10%）（11，13，14，16，17）。不幸的是，随机对照试验中的患者通常是高度选择性的，并且包括FN在内的毒性经常报告不足（18）。此外，RCT中很少报告化疗剂量强度和预防性CSF或抗生素的使用，因此难以评估与化疗方案相关的血小板减少并发症的真实负担（18）。
DOI: 10.1093/jnci/djr195© The Author 2011. Published by Oxford University Press. All rights reserved. Advance Access publication on June 13, 2011. For Permissions, please e-mail: journals. permissions@ oup. com. jnci. oxfordjournals. org JNCI| Editorials 911 remains high throughout the period of chemotherapy treatment (9). Initiation of the CSFs early in the first cycle of chemotherapy and continuation through all cycles of a chemotherapy regimen (primary prophylaxis) has been shown to substantially reduce the risk of FN as well as infection-related and early all-cause mortality, while decreasing the need for chemotherapy dose reductions and delays (10, 11). Furthermore, most of the pivotal trials of primary prophylaxis with CSFs permitted secondary prophylaxis after a neutropenic event in the control arms, providing reasonable evidence that primary prophylaxis is superior to secondary prophylaxis (10). There are also increasing data from randomized controlled trials (RCTs) of patients with solid tumors and lymphoma on the potential value of CSF support of chemotherapy to improve overall survival (12).The clinical practice guidelines for CSF use from the American Society of Clinical Oncology (ASCO)(13), the National Comprehensive Cancer Network (NCCN)(14), and the European Organization for Research and Treatment of Cancer (EORTC)(11), along with guidelines from the Infectious Diseases Society of America (IDSA)(15), recommend consideration of primary prophylaxis with CSF in patients at 20% or greater risk of FN. One of the risk factors for FN noted by the guideline panels is the specific chemotherapy regimen reported in RCTs, which is often classified as high risk (> 20%), intermediate risk (10%–20%), or low risk (< 10%) for FN (11, 13, 14, 16, 17). Unfortunately, patients in RCTs are often highly selected, and toxicities, including FN, are frequently under reported (18). In addition, chemotherapy dose intensity and the use of prophylactic CSF or antibiotics are infrequently reported in RCTs, making it difficult to assess the true burden of neutropenic complications associated with a chemotherapy regimen (18).