Jung Jae Hyup, Shin Dong Woo, Kim Jaihwan, Lee Jong-Chan, Hwang Jin-Hyeok
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center, Daegu 42601, Korea.
Cancers (Basel). 2020 Oct 27;12(11):3137. doi: 10.3390/cancers12113137.
Although FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) has been proven efficacious in metastatic pancreatic cancer (MPC), physicians hesitate to administer it due to its hematologic toxicities. We investigated the usefulness of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis. We reviewed electronic medical records of MPC patients with good performance status who were administered FOLFIRINOX as the first-line treatment from 2011 to 2017. The patients were divided into primary G-CSF prophylaxis users (group A) and non-users or therapeutic/secondary users (group B). Cumulative relative dose (cRDI), adverse effects (AEs), and overall survival (OS) were compared. A total of 165 patients (group A (57) vs. group B (108)) were investigated. Intergroup differences in baseline characteristics were not significant, although the cRDI and the number of treatment cycles were both higher in group A than in group B (cRDI: 80.6% vs. 73.9%, = 0.007; 9 vs. 6 cycles, = 0.004). Primary G-CSF prophylaxis reduced the risk of neutropenia (55.6% to 31.6%, = 0.003) and febrile neutropenia (18.5% to 1.8%, = 0.002) and improved OS (8.8 to 14.7 months; hazard ratio [HR]: 1.766, 95% CI: 1.257-2.481, = 0.001). When administering FOLFIRINOX for MPC, primary G-CSF prophylaxis could be rationalized to reduced AEs and improve survival; more prospective studies are needed.
尽管FOLFIRINOX方案（5-氟尿嘧啶、亚叶酸钙、伊立替康和奥沙利铂）已被证明对转移性胰腺癌（MPC）有效，但由于其血液学毒性，医生在使用时仍有所犹豫。我们研究了预防性使用重组人粒细胞集落刺激因子（G-CSF）的有效性。我们回顾了2011年至2017年期间接受FOLFIRINOX一线治疗、体能状态良好的MPC患者的电子病历。患者分为预防性使用G-CSF组（A组）和未使用或治疗性/继发性使用G-CSF组（B组）。比较了累积相对剂量（cRDI）、不良反应（AE）和总生存期（OS）。共纳入165例患者（A组57例 vs. B组108例）。尽管A组的cRDI和治疗周期数均高于B组（cRDI：80.6% vs. 73.9%，P = 0.007；9个周期 vs. 6个周期，P = 0.004），但两组的基线特征差异无统计学意义。预防性使用G-CSF可降低中性粒细胞减少症的风险（从55.6%降至31.6%，P = 0.003）和发热性中性粒细胞减少症的风险（从18.5%降至1.8%，P = 0.002），并改善总生存期（从8.8个月延长至14.7个月；风险比[HR]：1.766，95%可信区间：1.257 - 2.481，P = 0.001）。在MPC患者中使用FOLFIRINOX方案时，预防性使用G-CSF可合理地减少不良反应并提高生存率；仍需要更多前瞻性研究。
