Prophylaxis with granulocyte-colony stimulating factor (G-CSF) among patients with metastatic pancreatic adenocarcinoma (mPAC) associated with a higher likelihood of full dose intensity (DI) chemotherapy, which in turn tended to increase progression-free survival (PFS). These findings were published in The Oncologist.

To date, there remains little data on the relationship between G-CSF prophylaxis and its effect on DI and PFS.

Data for this analysis were pooled from 3 randomized clinical trials testing neutropenic polychemotherapy dosing. In this study, 498 patients who received 1 or more doses of chemotherapy were evaluated for the effect of G-CSF prophylaxis on DI and PFS. Patients were stratified by whether they received folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX), or folinic acid and irinotecan hydrochloride (FOLFIRI), or Nab-paclitaxel (NAB) chemotherapy.

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The study population comprised 58.0% men, 52.4% were aged 65 and older, and 64.1% received FOLFIRI/NAB. Most patients did not receive G-CSF prophylaxis (73.0%). G-CSF did not have a significant effect on the rate of febrile neutropenia (P =.13) or grades 3-4 neutropenia (P =.55).

Receiving full DI in the FOLFIRINOX cohort associated with G-CSF prophylaxis (odds ratio [OR], 5.07; P <.01) and having grades 3-4 gastrointestinal adverse events (OR, 4.72; P =.01). For the FOLFIRI/NAB group, full DI was less likely among patients who received G-CSF prophylaxis (OR, 0.23; P =.03) and those with grades 3-4 deterioration in general health (OR, 0.32; P =.03).

PFS tended to be associated with full DI in both the FOLFIRINOX (hazard ratio [HR], 0.83; P =.27) and FOLFIRI/NAB (HR, 0.84; P =.22) groups.

This study likely included selection bias due to sourcing data from previous studies.

Patients receiving FOLFIRINOX with G-CSF prophylaxis for mPAC were associated with increased likelihood of achieving full DI, which tended to increase PFS. Additional study is needed to relate G-CSF with DI.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Canton C, Boussari O, Boulin M, et al. Impact of G-CSF prophylaxis on chemotherapy dose-intensity, link between dose-intensity and survival in patients with metastatic pancreatic adenocarcinoma. Oncologist. 2022;27(7):e571-e579. doi:10.1093/oncolo/oyac055