Role of supportive care in the treatment of NSCLC: supportive care for myelotoxicity.

Chemotherapy-associated myelosuppression is a major limitation of anticancer therapy in both local advanced and metastatic NSCLC. In the past, primary prophylactic use of hematopoietic growth factors was administered in these patients to reduce the incidence of febrile neutropenia, to avoid dose reduction and dose delay, and to improve patient quality of life. However, so far, for myeloid growth factors significance is missing that response to treatment can be improved in terms of better outcome. Therefore, the routine use of primary for secondary prophylactic CSF in patients with stage III or IV NSCLC is discouraged. This is due to the fact that there is no evidence that intensified chemotherapy schedules improve patients' prognosis. The application of CSF may be considered (but not given routinely) in patients with pre-existing neutropenia due to diseases or (extensive) prior chemotherapy, poor performance status, previous radiotherapy of areas with large amounts of bone marrow reserve or a history of recurrent febrile neutropenia while receiving earlier therapy. However, none of these indications has ever been proven in randomised clinical trial. In contrast, locally advanced NSCLC is a potentially curable disease. Future schedules may combine increased dose intensity of chemotherapy with sequential or simultaneous radiotherapy, where the primary or secondary use of myeloid growth factors may be justified. Chemotherapy-associated thrombopenia: So far, no thrombopoietic factors are available for clinical use.