Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan; Department of Chemotherapy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
Cancer Treat Res Commun. 2021;29:100493. doi: 10.1016/j.ctarc.2021.100493. Epub 2021 Nov 20.
The clinical utility of prophylactic granulocyte-colony stimulating factor (G-CSF) in patients receiving platinum agents plus etoposide for neuroendocrine carcinoma (NEC) is unknown.
Chemotherapy-naïve patients with NEC who received platinum agents plus etoposide were retrospectively evaluated. The occurrence of severe neutropenia and febrile neutropenia (FN) and efficacy of chemotherapy were compared between patients who did (G-CSF group) and did not receive prophylactic G-CSF (non-G-CSF group).
Among 58 patients, 51 (87.9%) and 7 (12.1%) had small-cell lung cancer and large-cell NEC, respectively, and 24 (41.4%) and 34 (58.6%) received cisplatin and carboplatin, respectively. The G-CSF and non-G-CSF groups included 32 and 26 patients, respectively. The non-G-CSF group displayed significantly higher rates of grade 3-4 neutropenia {88.5% [95% confidence interval (CI) = 69.8% - 97.6%] vs. 56.2% [95% CI = 37.7% - 73.6%], P = 0.009} and FN [50.9% (95% CI = 30% - 70%) vs. 18.8% (95% CI = 7.2% - 36.4%), P = 0.023] than the G-CSF group. In multivariate analysis, non-G-CSF was an independent risk factor for grade 3-4 neutropenia and FN. The rate of treatment delay was significantly higher in the non-G-CSF group (69.2% vs. 31.2%, P = 0.001). The relative dose intensity was significantly higher in the G-CSF group (86.7% vs. 74.1%, P < 0.001). The overall response rate, progression-free survival, and overall survival were comparable between the two groups.
In patients with NEC receiving platinum agents plus etoposide, prophylactic G-CSF significantly reduced the risks of severe neutropenia and FN.
在接受铂类药物联合依托泊苷治疗的神经内分泌癌（NEC）患者中，预防性使用粒细胞集落刺激因子（G-CSF）的临床效果尚不清楚。
回顾性分析了接受铂类药物联合依托泊苷治疗的初治 NEC 患者。比较了接受预防性 G-CSF（G-CSF 组）和未接受 G-CSF（非 G-CSF 组）治疗的患者中严重中性粒细胞减少和发热性中性粒细胞减少（FN）的发生情况，以及化疗的疗效。
58 例患者中，小细胞肺癌和大细胞 NEC 分别为 51 例（87.9%）和 7 例（12.1%），顺铂和卡铂分别为 24 例（41.4%）和 34 例（58.6%）。G-CSF 组和非 G-CSF 组分别包括 32 例和 26 例患者。非 G-CSF 组 3-4 级中性粒细胞减少发生率明显高于 G-CSF 组[88.5%（95%CI：69.8%97.6%）比 56.2%（95%CI：37.7%73.6%），P=0.009]，FN 发生率也明显高于 G-CSF 组[50.9%（95%CI：30%70%）比 18.8%（95%CI：7.2%36.4%），P=0.023]。多因素分析显示，非 G-CSF 是 3-4 级中性粒细胞减少和 FN 的独立危险因素。非 G-CSF 组治疗延迟的发生率明显高于 G-CSF 组（69.2%比 31.2%，P=0.001）。G-CSF 组的相对剂量强度明显高于非 G-CSF 组[86.7%（95%CI：83.4%90.1%）比 74.1%（95%CI：70.4%77.9%），P<0.001]。两组患者的总缓解率、无进展生存期和总生存期相当。
在接受铂类药物联合依托泊苷治疗的 NEC 患者中，预防性使用 G-CSF 可显著降低严重中性粒细胞减少和 FN 的风险。
