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FN Despite G-CSF — SCE Medical Oncology MCQ

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EasyOncological EmergenciesFN Despite G-CSFSCE Medical Oncology

A 55-year-old woman receiving dose-dense AC chemotherapy for breast cancer presents 7 days post-chemotherapy with temperature 38.5°C and ANC 0.4 × 10⁹/L despite pegfilgrastim prophylaxis. What is the management?

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Correct answer: A — Treat as neutropenic sepsis per NICE CG151 — G-CSF prophylaxis reduces but does not eliminate FN risk; door-to-needle IV antibiotics within 1 hour

Pegfilgrastim prophylaxis reduces FN risk by approximately 50-70% but does not eliminate it. Patients who develop FN despite G-CSF prophylaxis should be managed per standard NICE CG151 protocols: immediate IV broad-spectrum antibiotics (piperacillin-tazobactam) within 1 hour of presentation. The presence of G-CSF prophylaxis does not alter the acute management of FN. Subsequent cycles require reassessment of chemotherapy dose and G-CSF adequacy.

Reference: NICE CG151; ESMO/ASCO G-CSF Guidelines