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Among patients with small-cell lung cancer, the combination of antibiotics and granulocyte colony-stimulating factor (G-CSF) is more effective than antibiotics alone at preventing febrile neutropenia during the first cycle of chemotherapy, according to a study published in the Journal of Clinical Oncology .

Small cell lung cancers (SCLC) account for 20-25% of all lung cancers and are primarily diagnosed in smokers or former smokers. They differ from other types of lung cancer in that they spread very quickly throughout the body via the blood and lymphatic system.

One of the most common treatment modalities used to treat SCLC and other cancers is chemotherapy. However, chemotherapy is associated with unpleasant and sometimes life-threatening side effects. Chemotherapy destroys not only cancer cells, but also normal cells that grow rapidly. These include blood cells forming in the bone marrow, cells in the hair follicles, or cells in the mouth and intestines.

Neutropenia, one of the most common side effects of chemotherapy, occurs when white blood cells (immune cells) are destroyed by chemotherapy, leaving the immune system unable to fight infections. Chemotherapy-induced neutropenia can become a serious condition for several reasons: Many patients who develop neutropenia will require a delay in treatment or a dose reduction, which can prevent them from receiving full benefits of treatment; patients who develop neutropenia may require hospitalization; and even minor infections can become life-threatening.

Prophylactic (preventive) treatment with antibiotics or G-CSF has been shown to reduce the probability of developing febrile neutropenia. G-CSF stimulates the growth of neutrophils, a type of white blood cell that fights infections.

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To determine whether treatment with a combination of antibiotics and G-CSF is more effective at preventing febrile neutropenia than treatment with antibiotics alone, researchers from the Netherlandsconducted a phase III clinical trial among 175 patients with SCLC. All patients were treated with the chemotherapy drugs cyclophosphamide, doxorubicin, and etoposide (CDE). Half the patients received prophylactic treatment with antibiotics alone and half received antibiotics plus G-CSF.

During the first cycle of chemotherapy, febrile neutropenia was more common in patients treated with antibiotics alone than in patients treated with antibiotics plus G-CSF. Febrile neutropenia developed in 24% of patients treated with antibiotics alone and 10% of patients treated with antibiotics plus G-CSF.

The researchers conclude that the combination of antibiotics plus G-CSF is effective in reducing the risk of febrile neutropenia during the first cycle of chemotherapy among patients with SCLC.

Reference: Timmer-Bonte JN, de Boo TM, Smit HJ et al. Prevention of Chemotherapy-Induced Febrile Neutropenia by Prophylactic Antibiotics Plus or Minus Granulocyte Colony-Stimulating Factor in Small-Cell Lung Cancer: A Dutch Randomized Phase III Study. Journal of Clinical Oncology. 2005;23:7974-7984.

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