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Open AccessArticle

Primary Granulocyte Colony-Stimulating Factor Prophylaxis in Metastatic Pancreatic Cancer Patients Treated with FOLFIRINOX as the First-Line Treatment

1
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
2
Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center, Daegu 42601, Korea
3
Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Seongnam 13620, Korea
*
Authors to whom correspondence should be addressed.
Cancers 2020, 12(11), 3137; https://doi.org/10.3390/cancers12113137
Received: 25 September 2020 / Revised: 22 October 2020 / Accepted: 24 October 2020 / Published: 27 October 2020
(This article belongs to the Special Issue Recent Advances in Pancreatic Ductal Adenocarcinoma)
Because FOLFIRINOX shows high prevalence of hematologic toxicity, it is meaningful to investigate of usefulness of primary G-CSF prophylaxis in metastatic pancreatic cancer patients. In this retrospective study, a total of 165 patients were divided into G-CSF user group (n = 57) and non-user group (n = 105). Baseline characteristics were not significantly different between two groups, which included initial absolute neutrophil counts and metastatic burden. Primary G-CSF prophylaxis reduced the risk of neutropenia (55.6% to 31.6%, p = 0.003) and febrile neutropenia (18.5% to 1.8%, p = 0.002) and improved OS (8.8 to 14.7 months; hazard ratio (HR): 1.766, 95% CI: 1.257–2.481, p = 0.001). When administering FOLFIRINOX for MPC, primary G-CSF prophylaxis could be rationalized to reduced AEs and improve survival, and more prospective studies are needed.
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%, p = 0.007; 9 vs. 6 cycles, p = 0.004). Primary G-CSF prophylaxis reduced the risk of neutropenia (55.6% to 31.6%, p = 0.003) and febrile neutropenia (18.5% to 1.8%, p = 0.002) and improved OS (8.8 to 14.7 months; hazard ratio [HR]: 1.766, 95% CI: 1.257–2.481, p = 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. View Full-Text
Keywords: pancreatic cancer; FOLFIRINOX; G-CSF prophylaxis pancreatic cancer; FOLFIRINOX; G-CSF prophylaxis
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MDPI and ACS Style

Jung, J.H.; Shin, D.W.; Kim, J.; Lee, J.-C.; Hwang, J.-H. Primary Granulocyte Colony-Stimulating Factor Prophylaxis in Metastatic Pancreatic Cancer Patients Treated with FOLFIRINOX as the First-Line Treatment. Cancers 2020, 12, 3137. https://doi.org/10.3390/cancers12113137

AMA Style

Jung JH, Shin DW, Kim J, Lee J-C, Hwang J-H. Primary Granulocyte Colony-Stimulating Factor Prophylaxis in Metastatic Pancreatic Cancer Patients Treated with FOLFIRINOX as the First-Line Treatment. Cancers. 2020; 12(11):3137. https://doi.org/10.3390/cancers12113137

Chicago/Turabian Style

Jung, Jae H.; Shin, Dong W.; Kim, Jaihwan; Lee, Jong-Chan; Hwang, Jin-Hyeok. 2020. "Primary Granulocyte Colony-Stimulating Factor Prophylaxis in Metastatic Pancreatic Cancer Patients Treated with FOLFIRINOX as the First-Line Treatment" Cancers 12, no. 11: 3137. https://doi.org/10.3390/cancers12113137

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