The Effects of GCSF Primary Prophylaxis on Survival Outcomes and Toxicity in Patients with Advanced Non-Small Cell Lung Cancer on First-Line Chemoimmunotherapy: A Sub-Analysis of the Spinnaker Study



Anpalakhan, Shobana, Huddar, Prerana, Behrouzi, Roya, Signori, Alessio, Cave, Judith, Comins, Charles, Cortellini, Alessio, Addeo, Alfredo, Escriu, Carles ORCID: 0000-0003-3638-3202, McKenzie, Hayley
et al (show 7 more authors) (2023) The Effects of GCSF Primary Prophylaxis on Survival Outcomes and Toxicity in Patients with Advanced Non-Small Cell Lung Cancer on First-Line Chemoimmunotherapy: A Sub-Analysis of the Spinnaker Study. INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, 24 (2). 1746-.

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Abstract

GCSF prophylaxis is recommended in patients on chemotherapy with a >20% risk of febrile neutropenia and is to be considered if there is an intermediate risk of 10−20%. GCSF has been suggested as a possible adjunct to immunotherapy due to increased peripheral neutrophil recruitment and PD-L1 expression on neutrophils with GCSF use and greater tumour volume decrease with higher tumour GCSF expression. However, its potential to increase neutrophil counts and, thus, NLR values, could subsequently confer poorer prognoses on patients with advanced NSCLC. This analysis follows on from the retrospective multicentre observational cohort Spinnaker study on advanced NSCLC patients. The primary endpoints were OS and PFS. The secondary endpoints were the frequency and severity of AEs and irAEs. Patient information, including GCSF use and NLR values, was collected. A secondary comparison with matched follow-up duration was also undertaken. Three hundred and eight patients were included. Median OS was 13.4 months in patients given GCSF and 12.6 months in those not (p = 0.948). Median PFS was 7.3 months in patients given GCSF and 8.4 months in those not (p = 0.369). A total of 56% of patients receiving GCSF had Grade 1−2 AEs compared to 35% who did not receive GCSF (p = 0.004). Following an assessment with matched follow-up, 41% of patients given GCSF experienced Grade 1−2 irAEs compared to 23% of those not given GCSF (p = 0.023). GCSF prophylaxis use did not significantly affect overall or progression-free survival. Patients given GCSF prophylaxis were more likely to experience Grade 1−2 adverse effects and Grade 1−2 immunotherapy-related adverse effects.

Item Type: Article
Uncontrolled Keywords: NSCLC, lung cancer, immunotherapy, GCSF, neutropenia, prophylaxis, immune-related toxicity, neutrophil-to-lymphocyte ratio (NLR), neuthrophils, outcome, overall survival
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Faculty Management Office
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 18 Apr 2023 15:00
Last Modified: 18 Apr 2023 15:00
DOI: 10.3390/ijms24021746
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3169663