Pegfilgrastim for the management of neutropenia during neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil in esophageal cancer patients

Background Neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy is a new standard for locally advanced esophageal squamous cell carcinoma. The optimal timing of pegfilgrastim with the DCF regimen to prevent febrile neutropenia (FN) remains controversial. The effectiveness of concomitan...

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Bibliographic Details
Published in:International journal of clinical oncology 2024-02, Vol.29 (2), p.142-148
Main Authors: Yoshimoto, Takanori, Oshima, Tadayuki, Fukada, Takashi, Imamura, Nobuko, Nakanishi, Takashi, Ebisutani, Nobuhiko, Morishita, Daisuke, Mieno, Masatoshi, Nakai, Keisuke, Sei, Hiroo, Kitayama, Yoshitaka, Eda, Hirotsugu, Okugawa, Takuya, Tomita, Toshihiko, Fukui, Hirokazu, Shinzaki, Shinichiro
Format: Article
Language:English
Subjects:
5-Fluorouracil
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Cancer Research
Chemotherapy
Cisplatin
Docetaxel
Esophageal cancer
Esophageal carcinoma
Esophageal Neoplasms - pathology
Esophageal Squamous Cell Carcinoma - drug therapy
Esophageal Squamous Cell Carcinoma - etiology
Esophagus
Filgrastim
Fluorouracil
Humans
Medicine
Medicine & Public Health
Multivariate analysis
Neoadjuvant Therapy
Neutropenia
Neutropenia - chemically induced
Neutropenia - drug therapy
Neutropenia - prevention & control
Oncology
Original Article
Polyethylene Glycols
Retrospective Studies
Risk factors
Squamous cell carcinoma
Surgical Oncology
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Summary:Background Neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy is a new standard for locally advanced esophageal squamous cell carcinoma. The optimal timing of pegfilgrastim with the DCF regimen to prevent febrile neutropenia (FN) remains controversial. The effectiveness of concomitant pegfilgrastim administration with continuous 5-fluorouracil (5-FU) infusion in the DCF regimen was therefore assessed. Methods All patients who received neoadjuvant DCF for esophageal cancer were retrospectively assessed. Patients who had been scheduled to receive pegfilgrastim on days 3–5 (early group) or days 7–9 (regular group) of the DCF regimen were included. Uni- and multivariate analyses were used to assess risk factors for FN. Results Eighty-eight patients were included in the analysis. The 26 patients in the early group received pegfilgrastim as scheduled. In the 62 patients of the regular group, 51 received pegfilgrastim at a median of 7 days after starting DCF chemotherapy. However, 11 patients in the regular group could not receive pegfilgrastim. Twenty-two patients of the regular group and 2 patients of the early group developed FN after the first session of DCF. Early administration of pegfilgrastim and grade 4 neutropenia were significantly associated with onset of FN, with multivariate analysis identifying early administration of pegfilgrastim as an independent preventive factor and grade 4 neutropenia as a risk factor, after adjusting for sex and age. Conclusion Early pegfilgrastim administration is a safe approach that reduces the incidence of FN in DCF therapy. Using pegfilgrastim with continuous 5-FU infusion in the DCF regimen represents a reasonable option to prevent FN.
ISSN:1341-9625
1437-7772
DOI:10.1007/s10147-023-02438-3