Secondary Prophylaxis With GCSF May Help Maintain Chemo Dose-Intensity

Secondary prophylaxis with granulocyte colony-stimulating factor (GCSF) showed a statistically significant improvement in the achievement of adequate relative dose intensity (RDI) in non-intensive chemotherapy regimens, a new study published online ahead of print in the journal Annals of Oncology has shown.¹

Because data have suggested that achievement of planned dose intensity may impact survival, researchers sought to compare GCSF with standard management following a first neutropenic event in achieving planned dose intensity.

For the study, researchers enrolled 407 adult patients receiving adjuvant or neoadjuvant chemotherapy for early breast cancer. Most regimens were anthracycline-based, which may have included a sequential taxane and/or were in clinical trials.

Following a first neutropenic event, defined as hospitalization due to neutropenic fever, an ANC < 1.5 x 10⁹/L requiring treatment delay, or dose reduction of ≥15% of planned dose, participants were randomly assigned to receive filgrastim for 7 days or pegfilgrastim as secondary prophylaxis or standard care.

Results showed that 75% of patients in the GCSF arm achieved 85% planned RDI compared with 50% of patients in the control arm (P<0.0001). Researchers also found that secondary prophylaxis was associated with a reduction in post-randomization neutropenic events, which occurred in 18.2% of the GCSF arm and 65.7% of controls.

“This may have important clinical implications for outcome,” the authors concluded.

Reference

1. Leonard RCF, Mansi JL, Keerie C, et al. A randomised trial of secondary prophylaxis using granulocyte colony stimulating factor (‘SPROG’ Trial) for maintaining dose-intensity of standard adjuvant chemotherapy for breast cancer – by the Anglo-Celtic Cooperative Group and NCRN [published online ahead of print September 28, 2015]. Ann Oncol. doi: 10.1093/annonc/mdv389.