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Neutropenic Sepsis — SCE Medical Oncology MCQ

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EasyOncological EmergenciesNeutropenic SepsisSCE Medical Oncology

A 65-year-old man receiving palliative chemotherapy for metastatic gastric cancer develops grade 4 febrile neutropenia after cycle 1 of FOLFOX (ANC 0.1 × 10⁹/L, temperature 39.5°C requiring ICU admission). After recovery, further chemotherapy is planned. What prophylactic measure is recommended for subsequent cycles?

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Correct answer: E — Primary prophylactic G-CSF (filgrastim or pegfilgrastim)

After an episode of grade 4 febrile neutropenia, secondary prophylaxis with G-CSF (granulocyte colony-stimulating factor) is recommended for subsequent cycles to maintain dose intensity and prevent recurrence. ESMO and ASCO guidelines recommend G-CSF when FN risk is ≥20% or when FN has already occurred. Dose reduction is also appropriate but G-CSF enables maintenance of adequate dose intensity. Pegfilgrastim (single injection per cycle) or daily filgrastim can be used.

Reference: ESMO/ASCO 2024 G-CSF Guidelines; NICE TA136 Pegfilgrastim and filgrastim for FN prevention