Colony-Stimulating Factors Including Biosimilars for At-Risk Patients

Granulocyte–colony-stimulating factors (G-CSF), granulocyte–macrophage-stimulating factors (GM-CSF) and colony-stimulating factor (CSF) biosimilars are substances that bind to hematopoietic stem cells, activating them to proliferate and differentiate into granulocytes and macrophages—the specific cell type of interest. CSFs administered systemically have been evaluated and recommended for patients with cancer for prevention of infection and febrile neutropenia (FN). CSFs may be used for primary or secondary prophylaxis. In primary prophylaxis, CSFs are administered with the first course of chemotherapy to prevent neutropenic sequelae. In secondary prophylaxis, CSFs are used for patients who had febrile neutropenia or infections during a prior course of therapy provided without CSF prophylaxis. The National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the European Organisation for the Research and Treatment of Cancer (EORTC) groups all have guidelines regarding the use of prophylactic CSF. Patients considered at risk are those in whom prolonged severe neutropenia is expected.