Dados do Trabalho

Título

IMPACT OF THE USE OF GRANULOCYTE COLONY-STIMULATING FACTOR (G-CSF) ON THE OUTCOME OF PATIENTS WITH METASTATIC PANCREATIC ADENOCARCINOMA TREATED WITH FOLFIRINOX: A RETROSPECTIVE ANALYSIS.

Introdução

Background: FOLFIRINOX stands as a major breakthrough in the management of
metastatic pancreatic ductal adenocarcinoma (PDAC). However, this protocol is associated
with a high frequency of neutropenia. Despite its frequent use in clinical practice, the role
of granulocyte colony-stimulating factor (G-CSF) prophylaxis during the treatment with
FOLFIRINOX is unclear.

Objetivo

We aimed to compare the frequency of grade 3-4 neutropenia and
febrile neutropenia (FN), and survival outcomes of patients who received primary G-CSF or
no primary G-CSF prophylaxis.

Método

Methods: We included patients aged ≥18 years-old, with pathologically confirmed
metastatic PDAC, treated with FOLFIRINOX in the first-line setting. Patients who received
primary prophylaxis (PP) were compared to patients who received secondary or no G-CSF.
Categorical variables were compared using Fisher’s exact test. Survival curves were
estimated using the Kaplan-Meier method and compared using log-rank test. We looked
for putative prognostic factors using univariate and multivariate Cox proportional hazard
models for progression-free survival and overall survival.

Resultado

Results: From January 2011 to December 2019, 123 subjects were included. Primary
prophylaxis was used in 75 patients (65%); most common G-CSF was peg-filgastrim. The
median first-line therapy durations was higher in this group compared to no-PP (7.9 vs. 5.6
months; P=0.02). Grade 3-4 neutropenia occurred more frequently among patients
without PP (10.7 vs. 41.7%; P < 0.001). Eight patients had FN (four on each group). All
patients with FN were hospitalized and two patients died. The majority of grade 3-4
neutropenia and FN occurred before cycle 8. Regarding survival analysis, PP patients had
better overall survival (OS) (15,2 vs. 10,8 months; P=0,01); there was no differences in
progression free survival (PFS). In univariate Cox analysis, PP was associated with 39%
reduction risk of death; in multivariate analysis, liver metastasis was associated with 1.79-
fold increased risk of death. PP was not associated with better prognosis.

Conclusão

Conclusion: Despite reducing the frequency of grade 3-4 neutropenia in metastatic PDAC
patients receiving FOLFIRINOX, PP was not an independent predictor of survival. Its use
should be individualized to high-risk patients and cost-effectiveness issues should be
discussed.

Palavras-chave

Pancreatic cancer; G-CSF; prognosis

Área

Oncologia - Tumores TGI Superior (estômago, esôfago, pâncreas, fígado, vias biliares, duodeno)