Skip to main content

Advertisement

SpringerLink
Log in

The impact of granulocyte colony-stimulating factor use in patients with metastatic breast cancer treated with palliative chemotherapy: a single-institution retrospective review

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The goal of chemotherapy for metastatic breast cancer (MBC) is palliation of symptoms while minimizing treatment-related toxicities. It remains unclear whether use of granulocyte colony-stimulating factor (G-CSF) to maintain relative dose intensity of chemotherapy for MBC is associated with improved clinical outcomes.

Methods

The medical records of MBC patients treated with chemotherapy in 1st–3rd-line settings between May 2010 and April 2014 were reviewed. Time to progression (TTP), progression-free survival (PFS), and overall survival (OS) were compared between patients who received G-CSF and those who did not. Antibiotic use, total clinic visits, and pre- and post-treatment Eastern Cooperative Oncology Group (ECOG) performance status were also compared between the groups.

Results

Of the 169 patients included, 55 (32.5%) received > 1 G-CSF dose and 114 (67.5%) did not receive any G-CSF. The median TTP was similar between the two groups (5.0 months (95% CI 3.4–7.1) vs. 5.2 months (95% CI 4.8–6.2) respectively; p = 0.998). The median PFS (p = 0.955; 5.0 months (95% CI 3.4–5.9) vs. 5.2 months (95% CI 4.7–6.0), respectively) and OS (14.6 (95% CI 9.0–26.6) vs. 18.5 months (95% CI 15.2–22.0) in G-CSF and non-G-CSF groups, respectively; p = 0.628) were also similar between groups. No significant between-group differences were noted in rate of decline in ECOG performance status, antibiotic use, and number of clinic visits and hospitalizations.

Conclusion

This retrospective analysis did not find any evidence that the use of G-CSF to maintain chemotherapy dose intensity for the treatment of MBC improves TTP, PFS, and OS or results in improved ECOG performance status compared with lack of G-CSF use in patients with MBC treated in 1st to 3rd-line settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29. https://doi.org/10.3322/caac.20138

    Article  PubMed  Google Scholar 

  2. Thun M, Jemal A, Ward E (2011) Global cancer incidence and mortality. In: Cancer: principles and practice of oncology, 9th edn. Lippincott Williams & Wilkins, Philadelphia, PA, pp 241–266

  3. (2014) Cancer facts & figures. In: Am. Cancer Soc. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2014.html. Accessed 24 Jan 2020

  4. Paridaens R, Biganzoli L, Bruning P, Klijn JG, Gamucci T, Houston S, Coleman R, Schachter J, van Vreckem A, Sylvester R, Awada A, Wildiers J, Piccart M (2000) Paclitaxel versus doxorubicin as first-line single-agent chemotherapy for metastatic breast cancer: a European Organization for Research and Treatment of Cancer randomized study with cross-over. J Clin Oncol Off J Am Soc Clin Oncol 18:724–733. https://doi.org/10.1200/JCO.2000.18.4.724

    Article  CAS  Google Scholar 

  5. Sledge GW, Neuberg D, Bernardo P et al (2003) Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an intergroup trial (E1193). J Clin Oncol Off J Am Soc Clin Oncol 21:588–592. https://doi.org/10.1200/JCO.2003.08.013

    Article  Google Scholar 

  6. Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, Shenkier T, Cella D, Davidson NE (2007) Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 357:2666–2676. https://doi.org/10.1056/NEJMoa072113

    Article  CAS  PubMed  Google Scholar 

  7. Murphy CG, Seidman AD (2009) Evolving approaches to metastatic breast cancer previously treated with anthracyclines and taxanes. Clin Breast Cancer 9(Suppl 2):S58–S65. https://doi.org/10.3816/CBC.2009.s.006

    Article  CAS  PubMed  Google Scholar 

  8. Lyman GH (2006) Chemotherapy dose intensity and quality cancer care. Oncol Williston Park N 20:16–25

    Google Scholar 

  9. Bonadonna G, Valagussa P (1981) Dose-response effect of adjuvant chemotherapy in breast cancer. N Engl J Med 304:10–15. https://doi.org/10.1056/NEJM198101013040103

    Article  CAS  PubMed  Google Scholar 

  10. Chirivella I, Bermejo B, Insa A, et al (2006) Impact of chemotherapy dose-related factors on survival in breast cancer patients treated with adjuvant anthracycline-based chemotherapy. J Clin Oncol Off J Am Soc Clin Oncol 24

  11. Hughes WT, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis Off Publ Infect Dis Soc Am 34:730–751. https://doi.org/10.1086/339215

    Article  Google Scholar 

  12. Prevention and treatment of cancer related infections version 1.2014. In: NCCN Clin Pract Guidel Oncol. https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf. Accessed 24 Jan 2020

  13. Vogel CL, Wojtukiewicz MZ, Carroll RR, Tjulandin SA, Barajas-Figueroa LJ, Wiens BL, Neumann TA, Schwartzberg LS (2005) 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 Off J Am Soc Clin Oncol 23:1178–1184. https://doi.org/10.1200/JCO.2005.09.102

    Article  CAS  Google Scholar 

  14. Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C, European Organisation for Research and Treatment of Cancer (2011) 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 47:8–32. https://doi.org/10.1016/j.ejca.2010.10.013

    Article  CAS  PubMed  Google Scholar 

  15. Smith TJ, Bohlke K, Lyman GH et al (2015) Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 33:3199–3212. https://doi.org/10.1200/JCO.2015.62.3488

    Article  CAS  PubMed  Google Scholar 

  16. Renner P, Milazzo S, Liu JP et al (2012) Primary prophylactic colony-stimulating factors for the prevention of chemotherapy-induced febrile neutropenia in breast cancer patients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007913.pub2

  17. Kuderer NM, Dale DC, Crawford J, Lyman GH (2007) Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol Off J Am Soc Clin Oncol 25:3158–3167. https://doi.org/10.1200/JCO.2006.08.8823

    Article  CAS  Google Scholar 

  18. Lyman GH, Dale DC, Culakova E, Poniewierski MS, Wolff DA, Kuderer NM, Huang M, Crawford J (2013) The impact of the granulocyte colony-stimulating factor on chemotherapy dose intensity and cancer survival: a systematic review and meta-analysis of randomized controlled trials. Ann Oncol 24:2475–2484. https://doi.org/10.1093/annonc/mdt226

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hansen F, Stenbygaard L, Skovsgaard T (1995) Effect of granulocyte-macrophage colony-stimulating factor (Gm-Csf) on hematologic toxicity induced by high-dose chemotherapy in patients with metastatic breast cancer. Acta Oncol 34:919–924. https://doi.org/10.3109/02841869509127205

    Article  CAS  PubMed  Google Scholar 

  20. Muhonen T, Jantunen I, Pertovaara H, Voutilainen L, Maiche A, Blomqvist C, Pyrhönen S, Kellokumpu-Lehtinen P (1996) Prophylactic filgrastim (G-CSF) during mitomycin-C, mitoxantrone, and methotrexate (MMM) treatment for metastatic breast cancer. A randomized study. Am J Clin Oncol 19:232–234. https://doi.org/10.1097/00000421-199606000-00004

    Article  CAS  PubMed  Google Scholar 

  21. Schnipper LE, Smith TJ, Raghavan D et al (2012) American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 30:1715–1724. https://doi.org/10.1200/JCO.2012.42.8375

    Article  PubMed  Google Scholar 

  22. Hematopoietic growth factors v2.2019. In: NCCN Clin Pract Guidel Oncol. https://www.nccn.org/professionals/physician_gls/pdf/growthfactors.pdf. Accessed 24 Jan 2020

  23. Potosky AL, Malin JL, Kim B, Chrischilles EA, Makgoeng SB, Howlader N, Weeks JC (2011) Use of colony-stimulating factors with chemotherapy: opportunities for cost savings and improved outcomes. J Natl Cancer Inst 103:979–982. https://doi.org/10.1093/jnci/djr152

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The project described was supported by the Stefanie Spielman Fund for Breast Cancer Research. Additional support was provided by the National Center for Advancing Translational Sciences (grant number UL1TR002733).

Author information

Authors and Affiliations

  1. Division of Hematology, The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center, A 332 C Starling Loving Hall, 320 W 10th Ave, Columbus, OH, 43210, USA

    Luay Mousa

  2. Center for Biostatistics, The Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA

    Julie A. Stephens

  3. Division of Pharmacy, The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Michael Berger

  4. Division of Medical Oncology, The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Bhuvaneswari Ramaswamy, Maryam Lustberg, Sagar Sardesai, Nicole Williams, Jeffrey VanDeusen, Daniel Stover, Mathew Cherian, Evan Morgan & Robert Wesolowski

Authors
  1. Luay Mousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie A. Stephens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bhuvaneswari Ramaswamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maryam Lustberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sagar Sardesai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicole Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jeffrey VanDeusen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel Stover
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mathew Cherian
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Evan Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Robert Wesolowski
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LM, JS, MB, BR, and RW provided substantial contributions to the conception or design of the work. All authors provided help with the acquisition, analysis, and interpretation of data for the work. All authors contributed to manuscript revision, read, and approved the submitted version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Luay Mousa.

Ethics declarations

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ohio State University Cancer IRB (OSU 2014C0124) and with the 1964 Helsinki declaration and its later amendments. The Ohio State Cancer Institutional Review Board (OSU IRB 2014C0124) approved the full waiver of the informed consent process due to the retrospective nature of the study.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 98 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mousa, L., Stephens, J.A., Berger, M. et al. The impact of granulocyte colony-stimulating factor use in patients with metastatic breast cancer treated with palliative chemotherapy: a single-institution retrospective review. Support Care Cancer 28, 5537–5545 (2020). https://doi.org/10.1007/s00520-020-05392-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05392-2

Keywords

Search

Navigation