Preventing fever during chemotherapy

This study examined the timing and effectiveness of G-CSF treatments during chemotherapy in breast cancer patients at risk for febrile neutropenia.

A common side effect of chemotherapy is neutropenia, a reduction in the number of neutrophils (the most common type of white blood cells). Neutrophils are a crucial part of the body's immune system and without which the body is unable to fight infections. Febrile neutropenia (FN) is defined as a fever (indicating an infection) that occurs in a patient with neutropenia. FN can lead to prolonged hospitalization, delay of chemotherapy and may be life threatening.

Granulocyte colony-stimulating factor (G-CSF) is a protein that stimulates the production of new white blood cells. Treatment with G-CSF is recommended for patients at an increased risk of developing FN, such as patients receiving certain chemotherapy regimens. However, G-CSF treatments are very expensive. Since the risk of FN is known to be highest during the first two cycles of chemotherapy, this study investigated whether G-CSF could be safely limited only to the first cycles of treatment.

167 patients beginning chemotherapy treatments and at an increased risk of developing FN were included in the study. Patients were randomly assigned to receive G-CSF either only during the first two chemotherapy cycles, or throughout all treatment cycles. 

10% of patients who received G-CSF throughout all chemotherapy cycles developed FN. In comparison, 36% of patients who received G-CSF only during the first two treatment cycles developed FN.  Among patients receiving G-CSF only during the first two treatment cycles, the incidence of FN was highest (24%) during the third chemotherapy cycle (the first without G-CSF).

This trial concluded that G-CSF treatments should be continued throughout all chemotherapy cycles. Limiting G-CSF treatment to the first two cycles of chemotherapy significantly increases the risk of febrile neutropenia.

Only a small number of patients were included in this study.

Consult with your physician regarding the risk of serious complications during chemotherapy and their prevention.