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DOI: 10.1055/s-0044-1789590
Practice Patterns and Incidence of Febrile Neutropenia in Patients Receiving Triplet Drug Chemotherapeutic Regimens in GUT Cancers: Do We Need to Add WBC Growth Factors? (ForGeT GCSF Study)
Authors
Abstract
Background and Objectives
There are limited data on the requirement and duration of white blood cell (WBC) growth factor (GF) administration in patients receiving biweekly docetaxel, oxaliplatin, leucovorin, 5 Fluorouracil (mFLOT) or modified FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, 5 Fluorouracil (mFOLFIRINOX) regimens.
Methods
The data of 749 patients with pancreatic, gastric, and colorectal adenocarcinomas treated with mFOLFIRINOX or mFLOT for at least three cycles between January 2018 and December 2022 were retrieved.
Results
Of the 749 patients, 387 (52%) received mFLOT, while 362 (48%) received mFOLFIRINOX. Increased use of GF was seen in patients with diabetes mellitus (70 vs. 53%; p < 0.001), prior chemotherapy (82 vs. 49%; p < 0.001), prior pelvic radiotherapy (89 vs. 54%; p < 0.001), prior surgery (70 vs. 49%; p < 0.001), and stage I to III cancers as opposed to stage IV cancers (61 vs. 48%; p = 0.006). The use of GF resulted in a statistically lesser incidence of all-grades neutropenia (2.6 vs. 18.4%; p < 0.001), grade 3/4 neutropenia (1.2 vs. 12.5%; p < 0.001), and the primary endpoint of febrile neutropenia (FN; 1.2 vs. 6.1%; p = 0.001). There were no differences in the incidence of all grades of neutropenia (3.7 vs. 1.9%; p = 0.527), grade 3/4 neutropenia, and the primary endpoint of FN (1.2 vs. 1.1%; p = 0.079) in patients receiving single-day versus multiday GF, respectively.
Interpretation and Conclusion
The use of GF reduces the rates of FN by approximately 80% in patients receiving mFLOT and mFOLFIRINOX, although incidences of FN are low with these regimens. The incidence of febrile neutropenia was similar with single-dose versus multiday GF in efficacy when administered with mFLOT and mFOLFIRINOX chemotherapy.
Authors' Contribution
All the authors contributed equally in data collection, data analysis, and approval of the final manuscript.
Publication History
Received: 08 April 2024
Accepted: 26 July 2024
Article published online:
16 September 2024
© 2024. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Link H. Current state and future opportunities in granulocyte colony-stimulating factor (G-CSF). Support Care Cancer 2022; 30 (09) 7067-7077
- 2 Smith TJ, Bohlke K, Lyman GH. et al; American Society of Clinical Oncology. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2015; 33 (28) 3199-3212
- 3 Crawford J, Caserta C, Roila F. ESMO Guidelines Working Group. Hematopoietic growth factors: ESMO Clinical Practice Guidelines for the applications. Ann Oncol 2010; 21 (Suppl. 05) v248-v251
- 4 Vogel CL, Wojtukiewicz MZ, Carroll RR. et al. First and subsequent cycle use of pegfilgrastim prevents febrile neutropenia in patients with breast cancer: a multicenter, double-blind, placebo-controlled phase III study. J Clin Oncol 2005; 23 (06) 1178-1184
- 5 Crawford J, Ozer H, Stoller R. et al. Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. N Engl J Med 1991; 325 (03) 164-170
- 6 Conroy T, Desseigne F, Ychou M. et al; Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364 (19) 1817-1825
- 7 Al-Batran SE, Homann N, Pauligk C. et al; FLOT4-AIO Investigators. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019; 393 (10184): 1948-1957
- 8 Ramaswamy A, Shah D, Bhargava P. et al. Modified FOLFIRINOX compared to Gemcitabine & nab-Paclitaxel in advanced pancreatic ductal adenocarcinoma: results of a match-pair analysis. Indian J Med Res 2023; 157 (01) 57-65
- 9 Ramaswamy A, Bhargava P, Srinivas S. et al. Perioperative modified FLOT versus EOX in locally advanced resectable gastric and gastro-oesophageal junction adenocarcinoma: results of a matched-pair analysis. J Gastrointest Cancer 2023; 54 (03) 820-828
- 10 Culakova E, Thota R, Poniewierski MS. et al. Patterns of chemotherapy-associated toxicity and supportive care in US oncology practice: a nationwide prospective cohort study. Cancer Med 2014; 3 (02) 434-444
- 11 Weycker D, Li X, Edelsberg J. et al. Risk and consequences of chemotherapy-induced febrile neutropenia in patients with metastatic solid tumors. J Oncol Pract 2015; 11 (01) 47-54
- 12 Crawford J, Moore DC, Morrison VA, Dale D. Use of prophylactic pegfilgrastim for chemotherapy-induced neutropenia in the US: a review of adherence to present guidelines for usage. Cancer Treat Res Commun 2021; 29: 100466