[Problems and recommendations for use of G-CSF in lung cancer patients with neutropenia after chemotherapy]

Reports are reviewed on G-CSF studies in neutropenia after lung cancer chemotherapy, especially randomized trials including our data. With preventive administration of G-CSF after dose-intensive chemotherapy in small-cell lung cancer, three studies showed that G-CSF shortened the duration of neutropenia, and reduced the incidence of neutropenic fever, the use of antibiotics and hospitalization with statistical significance, but showed no advantage in response rate or the incidence of infection-related death. And the effect on survival has not been proved clearly. When G-CSF was administered to afebrile neutropenic patients, it accelerated recovery from neutropenia significantly, but did not clearly reduce the incidence of neutropenic fever or infection. When G-CSF was administered to febrile neutropenic patients combined with antibiotics concurrently, it also could accelerate recovery of neutropenia significantly, but could not reduce neutropenic fever or infection compared with no CSF. For optimal use, it has not been proved when G-CSF should be started. Marginal therapy is considered to be administration in neutropenia with fever or infection and in severe neutropenia. Investigational therapy is considered for administration in neutropenia without fever or infection and use in clinical trials. Because no standard therapy with G-CSF has been established, additional clinical trials are necessary.