Optimal Primary Prophylaxis for Febrile Neutropenia During Neoadjuvant Cisplatin and 5-Fluorouracil Plus Docetaxel for Esophageal Cancer: A Retrospective Cohort Study

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-04-24 DOI:10.1002/cam4.70889

Ryosuke Kumanishi, Hiroya Taniguchi, Taiko Nakazawa, Takatsugu Ogata, Yuki Matsubara, Hiroyuki Kodama, Akinobu Nakata, Kazunori Honda, Toshiki Masuishi, Yukiya Narita, Shigenori Kadowaki, Masashi Ando, Masahiro Tajika, Tetsuya Abe, Kei Muro

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Abstract

Background

Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil (5-FU) (DCF) is the standard treatment for locally advanced esophageal cancer (LAEC). DCF is associated with a high risk of febrile neutropenia (FN), but the optimal primary prophylaxis remains unclear. The present study aimed to assess risk factors for FN and efficacy of primary prophylaxis using granulocyte colony-stimulating factor (G-CSF) and antibiotics in LAEC patients treated with DCF.

Methods

Patients with LAEC who received DCF as NAC between January 2016 and June 2022 at Aichi Cancer Center Hospital were retrospectively analyzed. DCF consisted of docetaxel 70 mg/m² on day 1, cisplatin 70 mg/m² on day 1, and 5-FU 750 mg/m² by continuous infusion over 5 days. The patients were divided into Cohort A [no G-CSF], B1 (G-CSF after day 6), and B2 (G-CSFon day 3–4). The efficacy of primary prophylaxis with G-CSF and antibiotics during the first cycle was evaluated. The potential FN risk factors were evaluated using univariate and multivariate analyses.

Results

Among the 156 patients with esophageal cancer who received DCF as NAC, 41 (26%) patients developed FN during the first cycle. Multivariate analysis revealed that prophylactic antibiotics (17% vs. 40%; adjusted OR, 0.34; 95% confidence interval [CI], 0.16–0.73; p = 0.006) and G-CSF (6% vs. 35%; adjusted OR, 0.14; 95% CI, 0.04–0.47; p = 0.002) were associated with lower FN incidence. The grade 3/4 neutropenia rates were 84%, 43%, and 13% in cohorts A, B1, and B2, respectively. FN incidence was 35%, 13%, and 0% in the respective cohorts. Treatment-related death occurred in 2% of patients, none of whom received G-CSF prophylaxis.

Conclusions

Prophylactic G-CSF and antibiotics reduce the risk of FN in patients with LAEC treated with DCF. Early timing of G-CSF administration showed a potential trend toward reduced FN risk and may offer additional benefits; however, these findings must be validated.

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食管癌新辅助顺铂+ 5-氟尿嘧啶+多西他赛治疗发热性中性粒细胞减少的最佳初级预防：一项回顾性队列研究

多西紫杉醇、顺铂、5-氟尿嘧啶（5-FU）（DCF）联合新辅助化疗（NAC）是局部晚期食管癌（LAEC）的标准治疗方案。DCF与发热性中性粒细胞减少症（FN）的高风险相关，但最佳的初级预防措施仍不清楚。本研究旨在评估发生FN的危险因素以及使用粒细胞集落刺激因子（G-CSF）和抗生素对接受DCF治疗的LAEC患者进行一级预防的效果。方法回顾性分析2016年1月至2022年6月在爱知县肿瘤中心医院接受DCF作为NAC的LAEC患者。DCF由多西他赛70 mg/m2（第1天）、顺铂70 mg/m2（第1天）和5- fu 750 mg/m2（连续输注5天）组成。将患者分为A组（无G-CSF）、B1组（第6天无G-CSF）和B2组（第3-4天无G-CSF）。评估第一周期G-CSF和抗生素一级预防的疗效。采用单因素和多因素分析评估FN的潜在危险因素。结果156例接受DCF作为NAC的食管癌患者中，41例（26%）患者在第一周期发生FN。多变量分析显示，预防性抗生素(17% vs. 40%；调整OR为0.34；95%置信区间[CI]， 0.16-0.73；p = 0.006)和G-CSF (6% vs. 35%；调整OR为0.14；95% ci, 0.04-0.47；p = 0.002)与FN发生率较低相关。在A、B1和B2组中，3/4级中性粒细胞减少率分别为84%、43%和13%。FN的发生率分别为35%、13%和0%。2%的患者出现治疗相关死亡，这些患者均未接受G-CSF预防治疗。结论预防性G-CSF和抗生素可降低DCF治疗LAEC患者FN发生的风险。早期给药G-CSF显示出降低FN风险的潜在趋势，并可能提供额外的益处；然而，这些发现必须得到验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.