Effectiveness of G-CSF in chemotherapy for digestive system tumors: a systematic review of the Clinical Practice Guidelines for the Use of G-CSF 2022 delineated by the Japan Society of Clinical Oncology

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发表日期：

2024年4月5日

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Mamoru Ito,
Yuta Okumura,
Kenta Nio,
Eishi Baba,
Yukinori Ozaki,
Hiroshi Nishio,
Eiki Ichihara,
Yuji Miura,
Makoto Endo,
Shingo Yano,
Dai Maruyama,
Tetsuhiro Yoshinami,
Nobuyuki Susumu,
Munetaka Takekuma,
Takashi Motohashi,
Nobuaki Ochi,
Toshio Kubo,
Keita Uchino,
Takahiro Kimura,
Yutaro Kamiyama,
Shinji Nakao,
Shinobu Tamura,
Hitomi Nishimoto,
Yasuhisa Kato,
Atsushi Sato,
Toshimi Takano,
Kenji Tsuchihashi

摘要

Background

Granulocyte colony-stimulating factor (G-CSF) reportedly reduces the risk of neutropenia and subsequent infections caused by cancer chemotherapy. Although several guidelines recommend using G-CSF in primary prophylaxis according to the incidence rate of chemotherapy-induced febrile neutropenia (FN), the effectiveness of G-CSF in digestive system tumor chemotherapy remains unclear. To address these clinical questions, we conducted a systematic review as part of revising the Clinical Practice Guidelines for the Use of G-CSF 2022 published by the Japan Society of Clinical Oncology.

Methods

This systematic review addressed two main clinical questions (CQ): CQ1: “Is primary prophylaxis with G-CSF effective in chemotherapy?”, and CQ2: “Is increasing the intensity of chemotherapy with G-CSF effective?” We reviewed different types of digestive system tumors, including esophageal, gastric, pancreatic, biliary tract, colorectal, and neuroendocrine carcinomas. PubMed, Cochrane Library, and Ichushi-Web databases were searched for information sources. Independent systematic reviewers conducted two rounds of screening and selected relevant records for each CQ. Finally, the working group members synthesized the strength of evidence and recommendations.

Results

After two rounds of screening, 5/0/3/0/2/0 records were extracted for CQ1 of esophageal/gastric/pancreatic/biliary tract/colorectal/ and neuroendocrine carcinoma, respectively. Additionally, a total of 2/6/1 records were extracted for CQ2 of esophageal/pancreatic/colorectal cancer, respectively. The strength of evidence and recommendations were evaluated for CQ1 of colorectal cancer; however, we could not synthesize recommendations for other CQs owing to the lack of records.

Conclusion

The use of G-CSF for primary prophylaxis in chemotherapy for colorectal cancer is inappropriate.