Trends in G-CSF use in 990 patients after EORTC and ASCO guidelines

Although international guidelines have standardised conditions for G-CSF administration, real practice seems to vary.

A large survey was undertaken in France following a three-step method. Data concerning 990 patients in seven main indications were collected prospectively and analysed for their compliance with international guidelines.

G-CSF prescription rate varied from 81% in non-Hodgkin lymphoma (NHL), 55% in ovarian, 44% in breast and 21% in colorectal cancer. The main criteria for G-CSF administration were a chemotherapy regimen with a high risk of neutropaenia (65%) and associated risk factors (51%). Public hospital practitioners prescribed G-CSF more frequently as primary prophylaxis, whereas prescriptions of recently graduated practitioners (or=16 years) were often proposed as secondary prophylaxis or as G-CSF therapy, i.e. during ongoing neutropaenia. In prophylactic settings, administration schedules were highly variable depending on molecules, with a first day of administration between days 1 and 3 after chemotherapy in 66%, but before the end of the chemotherapy infusion in 13% of the cases. Concerning lenograstim (38% of prescriptions) and filgrastim (20%), the mean treatment duration was 5.5 days, significantly shorter than in 1999 (7.8 days).

G-CSF prescription was mainly in compliance with international guidelines. However, some too early administrations during chemotherapy are at risk of increased myelosuppression and should be more clearly disadvised in next international guidelines.