Granulocyte colony stimulating factor(Lipoxen Technologies Ltd.)

The incidence of prostate cancer (PC) has recently increased in Japan. Androgen deprivation therapy (ADT) has been a key treatment in patients with castration‐sensitive PC (CSPC); however, resistance typically emerges through multiple mechanisms, leading to metastatic castration‐resistant PC (mCRPC). Taxane‐based therapy (i.e., docetaxel, cabazitaxel) has been standard care in patients with mCRPC. New evidence supporting the addition of androgen receptor signaling inhibitors (ARSIs, e.g., enzalutamide, abiraterone) to docetaxel and ADT for patients with metastatic CSPC (mCSPC) raises questions about the role of taxane‐based therapies and their optimal sequencing, as well as how to identify patients who may benefit from taxane‐based therapy. Here we review the evidence on taxane‐based therapy, including cabazitaxel, in the treatment of PC, with a focus on clinical and real‐world evidence from Japan. Cabazitaxel has proven effective for patients with mCRPC who have a history of ARSI and docetaxel use, and it is preferable to a second alternative ARSI, as indicated in the CARD study. The safety profile of cabazitaxel (particularly, the incidence of neutropenia) can be managed through prophylactic use of granulocyte colony‐stimulating factor, as well as a lower dosage and possibly variation of the dosage interval. However, a certain dose intensity is required because neutropenia has been identified as a potential prognostic indicator for treatment effectiveness. In the ARSI era for mCSPC, evidence on mCRPC treatment sequencing is limited. A better understanding of PC biology and the collection of real‐world data is essential for effective treatment and improved safety‐benefit outcomes.

The treatment of chronic neutropenias and control of neutropenia‐related infections remain challenging topics for pediatric and adult hematologists. This article aims to fill the gap in the treatment of neutropenias and, in combination with the previously published European guidelines on diagnosis of neutropenias, gives complete and comprehensive guidance on the whole management of patients with neutropenia. In terms of methodology, an Evidence‐Based Medicine team produced an evidence synthesis of the literature on the treatment of neutropenias. Then, according to the robustness of the evidence, consensus recommendations were elaborated and voted by an expert's panel from the Cooperation in Science and Technology European Network for the Innovative Diagnosis and Treatment of Chronic Neutropenias (https://eunet-innochron.eu/) and the Specialized Working Group on Granulocytes and Constitutional Bone Marrow Failure Syndromes of the European Hematology Association. Whenever evidence was not available, recommendations were based on the expert's panel opinion. Consensus‐based recommendations are related to granulocyte colony‐stimulating factor indications and schedule of administration, indications for hematopoietic stem cell transplantation, supportive treatments and measures, and new treatments that have been evolving over the recent years. These guidelines, rather than a numerical correction of the absolute neutrophil count, suggest a holistic, patient‐centered approach aiming at optimizing the management of chronic neutropenic patients and offering valuable and practical guidance to the hematologists for their daily clinical practice.