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Primary prophylactic granulocyte colony-stimulating factor according to ASCO guidelines has no preventive effect on febrile neutropenia in patients treated with docetaxel, cisplatin, and 5-fluorouracil chemotherapy

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Abstract

Background

The efficacy of primary prophylactic granulocyte colony-stimulating factor (G-CSF) in preventing febrile neutropenia (FN) in patients treated with docetaxel, cisplatin, and 5-fluorouracil (TPF) chemotherapy remains controversial. We compared the incidence of FN in patients treated with and without primary prophylactic G-CSF.

Methods

We performed a retrospective analysis of 142 patients with locally advanced head and neck or esophageal cancer treated with TPF between January 2009 and March 2017. Among them, 116 patients started TPF without primary prophylactic G-CSF (control group) while 26 patients were given primary prophylactic G-CSF from day 7 of the first cycle of TPF (prophylactic group).

Results

The incidence of grade 4 neutropenia during the first cycle of TPF was significantly higher in the control group than in the prophylactic group [58.6% (n = 68) vs. 30.8% (n = 8), p = 0.02]. However, the incidence of FN in the first cycle was not significantly different between the two groups [32 patients (27.5%) in the control group and 8 patients (30.8%) in the prophylactic group (p = 0.62)]. In addition, the mean relative dose intensity throughout all cycles of TPF, as well as the survival time and response after TPF, were also not significantly different between the two groups.

Conclusions

Primary prophylactic G-CSF from day 7 of the first cycle of TPF did not reduce the incidence of FN. Our findings suggest that the timing of primary prophylactic G-CSF, as recommended by the American Society of Clinical Oncology guidelines, should be modified to reduce the incidence of FN in TPF.

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Authors and Affiliations

  1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan

    Masahiro Kawahira, Tomoya Yokota, Satoshi Hamauchi, Yukio Yoshida, Takahiro Tsushima, Akiko Todaka, Nozomu Machida, Kentaro Yamazaki, Akira Fukutomi & Hirofumi Yasui

  2. Division of Medical Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan

    Sadayuki Kawai & Yusuke Onozawa

Authors
  1. Masahiro Kawahira
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  2. Tomoya Yokota
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  3. Satoshi Hamauchi
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  4. Sadayuki Kawai
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  5. Yukio Yoshida
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  6. Yusuke Onozawa
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  7. Takahiro Tsushima
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  8. Akiko Todaka
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  9. Nozomu Machida
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  10. Kentaro Yamazaki
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  11. Akira Fukutomi
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  12. Hirofumi Yasui
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Corresponding author

Correspondence to Tomoya Yokota.

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Conflict of interest

Kentaro Yamazaki has received honoraria from Yakult. The other authors have no conflict of interests to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Electronic supplementary material

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10147_2018_1306_MOESM1_ESM.docx

Supplementary material 1 Fig. S-1 Kaplan–Meier plot shows the rate of progression-free survival of patients in the control and prophylactic groups (n = 142). Fig. S-2 Kaplan–Meier plot shows the rate of overall survival of patients in the control and prophylactic groups (n = 142) (DOCX 63 KB)

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Kawahira, M., Yokota, T., Hamauchi, S. et al. Primary prophylactic granulocyte colony-stimulating factor according to ASCO guidelines has no preventive effect on febrile neutropenia in patients treated with docetaxel, cisplatin, and 5-fluorouracil chemotherapy. Int J Clin Oncol 23, 1189–1195 (2018). https://doi.org/10.1007/s10147-018-1306-3

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  • DOI: https://doi.org/10.1007/s10147-018-1306-3

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