The Awareness of Neutropenia in Chemotherapy (ANC) Study Group

The ANC study group, the US counterpart of INC-EU, is directed by American haematologists and oncologists Gary Lyman, MD, MPH, David Dale, MD and Jeffrey Crawford, MD. The remainder of the study group comprises biostatisticians and other medical professionals from around the world.

The Coordinating Centre for the ANC Study Group has now relocated to Duke University, Durham, North Carolina.

A comparison of international guidelines for the prevention of chemotherapy-induced neutropenia
Lyman GH Curr Opin Hematol 2011; 18:1-10
http://www.ncbi.nlm.nih.gov/pubmed/21042215

 

This review summarises current status of clinical practice guidelines for the prevention of febrile neutropenia (FN) in patients receiving cancer chemotherapy utilising myeloid growth factors. Several studies have demonstrated safety and efficacy of colony-stimulating factor (CSF) in cacner patients receiving myelosuppressive chemotherpay. Primary and secondary prophylaxis with CSF reduces incidence and severity of neutropenic events while supporting the delivery of full dose intensity of different chemotherpay regimens. In routine practice treatment of elderly cancer patients, chemotherapy dose reduction is still preferred over support with CSF to minimise the risk of neutropenia. The National Comprehensive Cancer Network (NCCN) guideline is updated annually. Updates of previous evidence-based recommendations from the American Society of Clinical Oncology (ASCO) and the European Organisation for Research and Treatment of Cancer (EORTC) are ongoing to alter recommendations on the use of myeloid growth factors. They currently recommend prophylactic CSF use in patients with a FN risk of ›20%.

• ‘Cancer Supportive Care: Advances in Therapeutic Strategies’ is a new book that addresses not only classical cancer support issues such as pain and nausea control, but also approaches for managing the complete range of symptoms, toxicities and complications¹.
• A prospective study of 976 cancer patients aged ≥ 70 found that 50% of patients received an actual RDI < 85%. Increasing age was associated with lower RDI, and increasing age alone did not increase the risk of haematological toxicity².
• An economic analysis of pegfilgrastim use found that once-per-cycle primary prophylactic treatment was cost-effective and cost-saving³.
• A study of breast cancer patients found that black women and women of lower socioeconomic status were more likely to receive non-standard adjuvant chemotherapy regimens⁴.
• Lyman et al. reviewed various clinical practice guidelines and found that all recommended the use of CSF where FN risk is ≥ 20%⁵.

1. Lyman G, and Crawford, J. [Eds.] Pub. Informa healthcare, New York (2008)
2. Shayne M, et al.: Dose intensity and hematologic toxicity in older cancer patients receiving systemic cancer chemotherapy. Cancer 2007; 110(7):1611-20
3. Eldar-Lissai A, et al.: Economic analysis of prophylactic pegfilgrastim in adult cancer patients receiving chemotherapy. Value Health 2008; 11(2):172-9
4. Griggs JJ, et al.: Social and racial differences in selection of breast cancer adjuvant chemotherapy regimens. J Clin Oncol 2007; 25(18):2522-7
5. Lyman G, and Shayne, M.: Granulocyte colony-stimulating factors: finding the right indication. Curr Opin Oncol 2007; 19(4):299-307