• Masahiro Kawahira, Tomoya Yokota, Satoshi Hamauchi, Sadayuki Kawai, Yukio Yoshida, Yusuke Onozawa, Takahiro Tsushima, Akiko Todaka, Nozomu Machida, Kentaro Yamazaki, Akira Fukutomi, and Hirofumi Yasui.
• Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-gun, Nagaizumi, Shizuoka, 411-8777, Japan.
• Int. J. Clin. Oncol. 2018 Dec 1; 23 (6): 1189-1195.

BackgroundThe efficacy of primary prophylactic granulocyte colony-stimulating factor (G-CSF) in preventing febrile neutropenia (FN) in patients treated with docetaxel, cisplatin, and 5-fluorouracil (TPF) chemotherapy remains controversial. We compared the incidence of FN in patients treated with and without primary prophylactic G-CSF.MethodsWe performed a retrospective analysis of 142 patients with locally advanced head and neck or esophageal cancer treated with TPF between January 2009 and March 2017. Among them, 116 patients started TPF without primary prophylactic G-CSF (control group) while 26 patients were given primary prophylactic G-CSF from day 7 of the first cycle of TPF (prophylactic group).ResultsThe incidence of grade 4 neutropenia during the first cycle of TPF was significantly higher in the control group than in the prophylactic group [58.6% (n = 68) vs. 30.8% (n = 8), p = 0.02]. However, the incidence of FN in the first cycle was not significantly different between the two groups [32 patients (27.5%) in the control group and 8 patients (30.8%) in the prophylactic group (p = 0.62)]. In addition, the mean relative dose intensity throughout all cycles of TPF, as well as the survival time and response after TPF, were also not significantly different between the two groups.ConclusionsPrimary prophylactic G-CSF from day 7 of the first cycle of TPF did not reduce the incidence of FN. Our findings suggest that the timing of primary prophylactic G-CSF, as recommended by the American Society of Clinical Oncology guidelines, should be modified to reduce the incidence of FN in TPF.

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