Efficacy and tolerability of granulocyte colony-stimulating factors in cancer patients after chemotherapy: A systematic review and Bayesian network meta-analysis

Yong Wang,Yong Li,Fen Liu,Ning Zhao,Liyao Xu,Biqi Fu,Lin Chen

doi:10.1038/s41598-019-51982-4

Abstract

The optimum granulocyte colony-stimulating factor (G-CSF) treatment for cancer patients after being treated with cytotoxic chemotherapy remains unknown. Therefore, a systematic review and Bayesian network meta-analysis were performed to assess the efficacy and tolerability of 11 G-CSF drugs on patients after chemotherapy. A total of 73 randomized controlled trials (RCTs) containing 15,124 cancer patients were included for the final network meta-analysis. Compared with pegfilgrastim, there were a higher risk with filgrastim for incidence of febrile neutropenia (FN) (OR [95% CI]: 1.63 [1.07, 2.46]), and a higher risk with short-acting G-CSF (S-G-CSF) biosimilar and lenograstim for incidence of bone pain (BP) (OR [95% CI]: 6.45 [1.10, 65.73], 5.12 [1.14, 26.12], respectively). Mecapegfilgrastim, lipegfilgrastim and balugrastim were best G-CSF drugs in reducing FN (cumulative probabilities: 58%, 15%, 11%, respectively). S-G-CSF biosimilar, empegfilgrastim, and long-acting G-CSF (L-G-CSF) biosimilar were best G-CSF drugs in reducing severe neutropenia (SN) (cumulative probabilities: 21%, 20%, 15%, respectively). Mecapegfilgrastim, balugrastim, lipegfilgrastim and L-G-CSF biosimilar were best G-CSF drugs in reducing BP (cumulative probabilities: 20%, 14%, 8%, 8%, respectively). Mecapegfilgrastim, lipegfilgrastim and balugrastim might be the most appreciate G-CSF drugs with both good efficacy and tolerability when treating cancer patients after cytotoxic chemotherapy.

Highlights

The optimum granulocyte colony-stimulating factor (G-CSF) treatment for cancer patients after being treated with cytotoxic chemotherapy remains unknown
It was found that pegfilgrastim was better than filgrastim in reducing febrile neutropenia (FN), and more tolerable than short-acting G-CSF (S-G-CSF) biosimilar and lenograstim in terms of the incidence of bone pain (BP)
Since FN is the main and severe adverse event for many chemotherapy regimens, and is intimately associated with chemotherapy-related mortality[83], FN was chosen as the primary outcome of the G-CSF drug treatment and a crucial indicator to evaluate the efficacy of G-CSF drugs

Summary

Introduction

The optimum granulocyte colony-stimulating factor (G-CSF) treatment for cancer patients after being treated with cytotoxic chemotherapy remains unknown. Mecapegfilgrastim, lipegfilgrastim and balugrastim might be the most appreciate G-CSF drugs with both good efficacy and tolerability when treating cancer patients after cytotoxic chemotherapy. Febrile neutropenia (FN) and severe neutropenia (SN) are the most common and serious complications of cancer patients after treatment with cytotoxic chemotherapy[1] These complications lead to chemotherapy delay, dose reduction, and increased risk of infection[2]. Granulocyte colony-stimulating factors (G-CSFs) promote the growth of neutrophils, decrease the incidence of FN and SN, shorten the time of hospital stay, reduce the severity and duration of neutropenia, decrease the risk of infection, and improve the tolerance to cytotoxic chemotherapy[6]. Long-acting G-CSFs (L-G-CSFs) are PEGylated forms of short-acting G-CSFs (S-G-CSFs) with decreased elimination and increased half-life in serum after subcutaneous injection Some of these new G-CSF biosimilar drugs are not as glycosylated as filgrastim[8]. Since the structure and mechanism of drugs differ, the effect of different G-CSFs remains unclear

Methods

Results

Conclusion