Neutropenic events associated with new anticancer treatments, from pathophysiology to practice: a scoping review—NEW Group (Neutropenic Events Working Group)

Abstract

Introduction: New anticancer agents are increasingly being prescribed, either in combination or as a replacement or maintenance therapy after conventional chemotherapy. Although they present certain previously unknown complications, they are also responsible for more classic hematological toxicities, such as neutropenia. Unlike conventional chemotherapy, the comprehension and management of NAN (Neutropenia Associated with Novel anticancer agent) is currently poorly codified and understood. Methods: A literature scoping review was conducted by the NEW Group (Neutropenic Events multidisciplinary Working Group) to provide an overview of the pathophysiological mechanisms, epidemiology and management of NAN (neutropenia associated with new anticancer agents CDK4/6 inhibitors, PARP inhibitors, checkpoint inhibitors (anti-PD1, anti-PDL1 and anti-CTLA4), anti-CD20 and CAR T cells. Results: NAN is a frequent hematological toxicity, with mechanisms varying greatly between molecules. Unlike chemotherapy, its onset time, detection, and management must be tailored to the treatment type and patient’s profile. Granulocyte colony-stimulating factor (G-CSF) prophylaxis should not be done systematically and may even be detrimental in specific situations. Conclusion: Neutropenia is a frequent complication of new anti-cancer agents, that requires a dedicated and specific education. The different management procedures differ according to the mechanisms involved, including treatment discontinuation, dose reduction, immunosuppressive drugs use and, G-CSF in specific situations and according to local authorizations and/or recommendations of learned societies.