Abstract
BackgroundThe docetaxel, 5-fluorouracil, and cisplatin (DCF) regimen is an effective form of chemotherapy for advanced esophageal cancer. However, the incidence of adverse events such as febrile neutropenia and hematological toxicity is high.MethodsAmong 937 patients with esophageal cancer at Toranomon Hospital between January 2011 and December 2018, 92 who underwent the DCF regimen as initial treatment were selected. We investigated the risk factors for febrile neutropenia in patients with esophageal cancer treated with DCF regimen and the effectiveness of pegfilgrastim as primary prophylaxis.ResultsAdverse events (CTCAE grade ≥ 3) were observed in 45 of the 92(48.9%) patients with esophageal cancer treated with an initial DCF regimen. Febrile neutropenia was observed in 20 (21.7%) patients. Non-use of pegfilgrastim (odds ratio = 16.393; 95% confidence interval 2.049–125.0) as primary prophylaxis was identified as an independent factor predictive of febrile neutropenia. The pegfilgrastim group had a significantly lower incidence of neutropenia than the control group (9.1% vs 61.0%; p < 0.001). The incidence of febrile neutropenia was 3.0% in the pegfilgrastim group and 32.2% in the control group (p = 0.001). In addition, the incidence of any adverse effect ≥ CTCAE grade3 was also significantly lower in the pegfilgrastim group (12.1% vs 69.5%; p < 0.001). The reduced/interruption rate of next DCF therapy was 6.1% in the pegfilgrastim group and 30.5% in the control group (p = 0.006).ConclusionThis study revealed that the non-use of pegfilgrastim was an independent factor predictive of febrile neutropenia in multivariate analysis. Pegfilgrastim as primary prophylaxis prevents severe neutropenia and febrile neutropenia in patients with esophageal cancer treated with the DCF regimen.
Highlights
Esophageal cancer is one of the most malignant forms of gastrointestinal cancer
Patient characteristics and univariate analysis of the 92 patients Of the 92 patients, febrile neutropenia was observed in 20 (21.7%) patients. These 20 patients were allocated to the FN group, and the remaining 72 patients were allocated to the N group
All 92 patients who underwent DCF therapy as initial treatment had a median age of 66.5 years, and 85.9% of patients were male
Summary
Esophageal cancer is one of the most malignant forms of gastrointestinal cancer. The efficacy of chemoradiotherapy and chemotherapy has been demonstrated, and so they are widely used to treat esophageal cancer. A more potent form of preoperative treatment is desirable For this reason, there has been a growing number of reports on the DCF regimen (docetaxel + CF) as this is the more potent form of treatment in recent years [2–4], and the high success rate has attracted attention. There has been a growing number of reports on the DCF regimen (docetaxel + CF) as this is the more potent form of treatment in recent years [2–4], and the high success rate has attracted attention On this background, we are currently in the late stages of JCOG1109, a phase 3 comparative clinical trial [5] to clarify the superiority of the preoperative DCF regimen and preoperative CF chemoradiotherapy compared to the standard preoperative CF regimen. The incidence of adverse events such as febrile neutropenia and hematological toxicity is high
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