Comparing risk models guiding growth factor use in chemotherapy
Background The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) have guidelines for using colony-stimulating factors (CSF) for chemotherapy-induced neutropenia (CIN). Both groups recommend CSF if the chemotherapy has a risk for febrile neutropenia of more than 20%. The guidelines are less definitive if the risk is intermediate (10%-20%). Two risk models developed by Hosmer and Bozcuk and their respective colleagues may provide guidance regarding CSF decision making in this intermediate risk population.
Objective To examine whether risk models developed by Hosmer and Bozcuk had adjunct value to the NCCN and ASCO guidelines when applied to patients with lung cancer who were receiving intermediate-risk chemotherapy.
Methods Male and female patients aged 18-75 years with a diagnosis of any stage lung cancer, small or non-small cell, who required and received their initial chemotherapy at Drexel University in Philadelphia were included in this study. Patients who received growth factor before their chemotherapy were excluded. The Hosmer and Bozcuk calculators for febrile neutropenia risk and the NCCN and ASCO guidelines for using CSF for CIN were applied to this group of patients.
Results 43 patients were included in the study. The Hosmer and Bozcuk calculators and NCCN and ASCO guidelines recommended giving CSF to 26, 22, 25, and 38 patients, respectively. The sensitivities for detecting severe CIN were 89%, 78%, 67%, and 97%, and the specificities were 44%, 56%, 45%, and 14%, respectively.
Limitations Small cohort size; data were limited in scope.
Conclusions In lung cancer patients receiving intermediate-risk chemotherapy, the Hosmer calculator had the best combination of sensitivity, specificity, and ease of use. The NCCN guidelines were less sensitive, whereas the ASCO guidelines were the least specific. Based on these findings, we recommend using the Hosmer calculator because it lends to accurate but judicious use of CSF.
Accepted for publication November 2, 2018
Correspondence Chetan Jeurkar, DO; jeurkar2@gmail.com
Disclosures The authors report no disclosures/conflicts of interest.
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0429
Limitations
There were several limitations in our study. First, the size of the cohort was small, and, therefore, the data that we gathered was limited in its scope. However, the goal of this study was to help provide guidance to oncologists in real-world settings about the validity and use of the available risk calculators. A further study should compare the calculators and guidelines in a much larger cohort to see if present results still hold true.
The second possible limitation of the study was our application of the Hosmer calculator because our patient population did not fit the criteria for inclusion in their original study. Hosmer had included only the first cycle of chemotherapy, whereas we included all cycles of chemotherapy. However, despite that, the calculator still performed well and could predict severe CIN and FN even with later cycles of chemotherapy. Therefore, we suggest using this calculator in any cycle of chemotherapy rather than just the first. This would expand its scope and utility in clinical practice.
Conclusions
This article provides oncologists with a comparison of 2 CIN risk models with the currently available NCCN and ASCO guidelines for use in patients with lung cancer. We prefer the Hosmer calculator over the Bozcuk calculator because of its simplicity of use and the accuracy of results. We anticipate that it may be useful and practical as an adjunct tool to the NCCN or ASCO guidelines in patients receiving intermediate-risk chemotherapy regimens. Larger studies combining the calculators and determining accuracy need to be completed to prove this hypothesis.
