Evidence-based use of colony-stimulating factors in elderly cancer patients

Neutropenia and its complications represent the major dose-limiting toxicity of cancer chemotherapy, especially in the elderly. Hematopoietic growth factors have been shown to reduce the severity and duration of febrile neutropenia (FN) and to sustain chemotherapy dose intensity.

A systematic review was undertaken of studies of the relationship between age and the risk of neutropenia and its complications. Recent studies of the "Awareness of Neutropenia in Chemotherapy Study Group" related to the impact of age on neutropenic complications are also summarized.

The risk of FN associated with standard regimens increases with age and appears to be greatest during the first cycle of chemotherapy. FN continues to have a considerable clinical, economic, and quality-of-life impact on affected individuals. The risk of mortality associated with hospitalization with FN also increases with age but is largely associated with the higher rate of comorbidities observed in the elderly population. Despite increasing evidence that elderly patients experience similar benefit from cancer chemotherapy, reductions in dose intensity often compromise response rates and long-term survival. The hematopoietic growth factors reduce the risk of neutropenic events and the need for reduced dose intensity in elderly cancer patients. Primary prophylaxis with colony-stimulating factors (CSFs) reduces the risk of FN and its complications in elderly patients receiving moderately intensive systemic chemotherapy for responsive malignancies. CSFs also appear to reduce cost and improve quality of life in selected elderly patients receiving chemotherapy.

Primary prophylaxis with CSFs should be considered in elderly patients with responsive and potentially curable malignancies who receive moderately intensive chemotherapy.