The Multinational Association of Supportive Care in Cancer (MASCC) just released the guidance statement, Febrile Neutropenia in Patients Treated with Chemotherapy/Immune Checkpoint Inhibition, to address the large number of patients treated with combined chemotherapy/immune checkpoint inhibitor (ICI) regimens who may benefit from the clinical guidance. The 2026 MASCC febrile neutropenia in patients treated with chemotherapy/ICI guidance includes ten position points on the acute ambulatory management of low-risk febrile neutropenia in patients treated with combined chemotherapy/ICI regimens.

Today, we’re highlighting those ten position points, which cover topics including using the MASCC score for risk stratification, initial treatment of suspected ICI-mediated neutropenia, and telemedicine. For the complete look at the ten statements, along with their supporting rationales and recommendation grades, view the full-text version of the 2026 MASCC guidance statement.

Statements from the 2026 MASCC Febrile Neutropenia in Patients Treated with Chemotherapy/ICI
  • Increasing numbers of emergency presentations in cancer patients means alternative pathways, such as outpatient ambulatory emergency care, are required to ensure sustainable services and improve outcomes.
  • Risk stratifying patients with febrile neutropenia as high or low risk is essential to personalize acute management and optimize use of healthcare resources.
  • The MASCC score is a well-validated score for risk stratification in febrile neutropenia and patients with a score ≥ 21 are likely to be suitable for outpatient or ambulatory emergency care.
  • There is a lack of prospective and real-world data in the management of toxicities from newer regimens, such as combined chemotherapy/immune checkpoint inhibition.
  • Patients treated with chemotherapy/ICI presenting with febrile neutropenia and a MASCC risk index < 21 are high risk and require standard neutropenic sepsis management.
  • Patients treated with chemotherapy/ICI therapy with low-risk febrile neutropenia should be treated on the same pathway as those treated with chemotherapy alone with inclusion criteria adapted to recognize their eligibility if required.
  • Empirical usage of high-dose steroids in patients presenting with febrile neutropenia on chemo/ICI therapy with grade ≥ 3 diarrhea and/or transaminitis should be carefully balanced against the severity of sepsis, need of investigation for infective pathogens and clinical suspicion that presentation is ICI mediated.
  • ICI-mediated neutropenia should be considered in patients receiving combined chemotherapy/ICI therapy when the timing of presentation is unanticipated or there is a failure of neutrophil recovery with persistent grade 3/4 neutropenia 10 days following administration.
  • Initial treatment of suspected ICI-mediated neutropenia is to commence high-dose steroids (for example, 1 mg/kg oral prednisolone) and consider short-acting G-CSF.
  • Telemedicine and provision of remote monitoring using patient-reported outcome measures are increasingly important adjuncts to acute ambulatory cancer management programs, such as low-risk febrile neutropenia.

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