The most common chemotherapeutic agents in the treatment
of breast cancer are anthracyclines and taxanes.
The major dose-limiting toxicities associated with these
agents are myelosuppression and associated febrile neutropenia
(FN). FN can significantly impact the ability to
deliver full-dose chemotherapy on schedule and as a result
may increase the risk of disease recurrence and
eventual disease-related mortality. The use of granulocyte
colony stimulating factors (G-CSFs) significantly improves
the management of FN, both in a therapeutic and
in a prophylactic approach. Nevertheless, the high cost
of these agents limits their widespread prophylactic use.
Therefore, the identification of patients who are at a
higher risk of developing FN and who will benefit from
the prophylactic use of G-CSFs has become the subject
of several clinical and cost-effectiveness studies. Recently,
new data have been accumulated concerning the risk
of FN in different chemotherapy regimens, and different
risk models have been developed to assess the neutropenic
risk with all its complications. This article reviews
and summarizes cutting-edge, disease-specific
data as well as national and international guidelines regarding
the use of G-CSFs to prevent chemotherapy-induced
FN, with focus on the treatment of breast cancer.
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