Febrile Neutropenia: Disease Burden, G-CSF Prophylactic Treatment Options, and Future Expectations in Patients Undergoing Chemotherapy

INTRODUCTION: Febrile neutropenia (FN) is an acquired and benign blood disorder that is prevalent in patients who are diagnosed with cancer and undergo chemotherapy. FN can cause patients to experience signs and symptoms like fever, pain, and infections. Around 89% to 94% of all cancer patients experience FN during their chemotherapy sessions. Standard laboratory tests must be taken during chemotherapy treatment to evaluate ANC levels. Absolute neutrophil count (ANC) recovery is defined at 1.5 x10^9/L or greater. The standard of care is to provide Granulocyte-Colony Stimulating Factor (G-CSF) injections to all cancer patients. G-CSFs are injections used to stimulate granulocytes and stem cells in patients experiencing FN. METHOD: A structured literature search of PubMed was conducted six different times for each type of G-CSF using the term neutropenia. Comparative data on filgrastim, sargramostim, pegfilgrastim, lenograstim, eflapegrastim, and efbemalenograstim alfa used in patients undergoing chemotherapy were extracted and qualitatively summarized. RESULTS: The primary outcome is the comparison of total duration of severe neutropenia while undergoing prophylactic G-CSF treatment. Results demonstrate that G-CSFs are all efficacious in decreasing the total duration of severe neutropenia. The main adverse effect that patients experience is bone pain, and data shows that incidence of bone pain decreases with newer formulations. DISCUSSION/CONCLUSION: G-CSFs are used as preventive care in patients with cancer who are undergoing chemotherapy and are experiencing FN. There are growing G-CSF options as longer-acting formulations demonstrate higher efficacy, where over time, adverse effects become more tolerable with newer formulations.