Abstract
Although PEGylated filgrastim-induced aortitis is very rare and unknown clinically, some cases were reported and increasing, especially in breast cancer patients. The present study investigated the prevalence, clinical features and treatment of aortitis induced by PEGylated filgrastim in patients with breast cancer. A total of 2068 consecutive patients who underwent neoadjuvant/adjuvant chemotherapy with PEGylated filgrastim for breast cancer were enrolled. From the medical record, clinical, laboratory, medication, and imaging evaluation findings were collected. PEGylated filgrastim-induced aortitis was established in 0.3% of the study population. Common clinical presentations included extremely high fever and chest/back pain with high levels of inflammatory markers without any signs of infection. Contrast-enhanced computed tomography scans revealed typical enhancing wall thickening and periaortic soft tissue infiltration at various levels of aorta. All patients improved rapidly after treatment with modest doses of prednisolone (0.5 mg/kg/day) without any complications. Clinicians should be aware of aortitis as a possible complication of granulocyte-colony stimulating factor therapy, especially PEGylated filgrastim, given the frequent misdiagnoses in neutropenic patients undergoing chemotherapy.
Highlights
PEGylated filgrastim-induced aortitis is very rare and unknown clinically, some cases were reported and increasing, especially in breast cancer patients
Recombinant human granulocyte-colony stimulating factors (G-CSF) are widely used for primary or secondary prevention of chemotherapy-induced neutropenia in patients treated with anticancer agents
In the absence of large-scale data other than those derived from case reports or adverse drug reports, we sought to investigate the prevalence, clinical features and treatment of G-CSF-induced acute aortitis in patients treated with adjuvant or neoadjuvant chemotherapy and PEGylated filgrastim for breast cancer
Summary
PEGylated filgrastim-induced aortitis is very rare and unknown clinically, some cases were reported and increasing, especially in breast cancer patients. The present study investigated the prevalence, clinical features and treatment of aortitis induced by PEGylated filgrastim in patients with breast cancer. Aortitis is a rare clinical manifestation caused by multiple etiologies including infection or autoimmune disease[1,2]. PEGylated filgrastim, usually used for primary prophylaxis of neutropenia in breast cancer patients, is known to be associated with the highest incidence of aortitis among G-CSF agents. In the absence of large-scale data other than those derived from case reports or adverse drug reports, we sought to investigate the prevalence, clinical features and treatment of G-CSF-induced acute aortitis in patients treated with adjuvant or neoadjuvant chemotherapy and PEGylated filgrastim for breast cancer. Years Sex Female Male Chemotherapy indication Neoadjuvant Adjuvant Chemotherapy regimen Doxorubicin + cyclophosphamide Docetaxel + cyclophosphamide Docetaxel + doxorubicin + cyclophosphamide Docetaxel + carboplatin Others G-CSF with chemotherapy PEGylated filgrastim
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