PDF(Pubmed)
Abstract：
OBJECTIVE: A high risk of febrile neutropenia (FN) from neoadjuvant chemotherapy with docetaxel, cisplatin, and fluorouracil (DCF) for esophageal cancer has been reported. The optimal timing of prophylactic use of pegfilgrastim remains to be elucidated. To evaluate the effect of pegfilgrastim administered on day 3, we conducted a feasibility study.
METHODS: Chemotherapy consisted of intravenous administration of docetaxel (70 mg/m2 per day) and cisplatin (70 mg/m2 per day) on day 1 and continuous infusion of 5-fluorouracil (750 mg/m2 per day) on days 1-5. Pegfilgrastim was given as a single subcutaneous injection at a dose of 3.6 mg on day 3 during each treatment course. This regimen was repeated every 3 weeks for up to a maximum of three courses. Prophylactic antibiotics were not needed but were allowed to be given at the discretion of the physician. The primary endpoint was the incidence of FN.
RESULTS: Twenty-six patients were administered DCF in combination with pegfilgrastim on day 3. After the first course of DCF, 10 out of 26 patients (38.5%) experienced grade 4 neutropenia, and two patients (7.7%) experienced FN. Of the 14 patients who did not receive prophylactic antibiotics, four had grade 4 neutropenia, including two who developed FN. On the contrary, of the 12 patients who received prophylactic levofloxacin, six had grade 4 neutropenia, but no cases of FN were observed.
CONCLUSIONS: Administration of pegfilgrastim on day 3 was not sufficient to prevent FN due to DCF treatment, and prophylactic administration of both pegfilgrastim and antibiotics could be a solution.
METHODS: Chemotherapy consisted of intravenous administration of docetaxel (70 mg/m2 per day) and cisplatin (70 mg/m2 per day) on day 1 and continuous infusion of 5-fluorouracil (750 mg/m2 per day) on days 1-5. Pegfilgrastim was given as a single subcutaneous injection at a dose of 3.6 mg on day 3 during each treatment course. This regimen was repeated every 3 weeks for up to a maximum of three courses. Prophylactic antibiotics were not needed but were allowed to be given at the discretion of the physician. The primary endpoint was the incidence of FN.
RESULTS: Twenty-six patients were administered DCF in combination with pegfilgrastim on day 3. After the first course of DCF, 10 out of 26 patients (38.5%) experienced grade 4 neutropenia, and two patients (7.7%) experienced FN. Of the 14 patients who did not receive prophylactic antibiotics, four had grade 4 neutropenia, including two who developed FN. On the contrary, of the 12 patients who received prophylactic levofloxacin, six had grade 4 neutropenia, but no cases of FN were observed.
CONCLUSIONS: Administration of pegfilgrastim on day 3 was not sufficient to prevent FN due to DCF treatment, and prophylactic administration of both pegfilgrastim and antibiotics could be a solution.
摘要：
目的：多西他赛新辅助化疗导致高热中性粒细胞减少症（FN）的风险，顺铂,和氟尿嘧啶（DCF）治疗食管癌已有报道。预防性使用pegfilgrastim的最佳时机仍有待阐明。为了评估第3天服用pegfilgrastim的效果，我们进行了一项可行性研究。
方法:化疗包括在第1天静脉内施用多西他赛(每天70mg/m2)和顺铂(每天70mg/m2),以及在第1-5天连续输注5-氟尿嘧啶(每天750mg/m2)。在每个治疗过程中的第3天以3.6mg的剂量给予Pegfilgrastim单次皮下注射。该方案每3周重复一次,最多三个疗程。不需要预防性抗生素，但允许医生酌情给予。主要终点是FN的发生率。
结果：26名患者在第3天联合给予DCF和pegfilgrastim。在DCF的第一个疗程之后，26例患者中有10例（38.5％）经历了4级中性粒细胞减少症，和两名患者（7.7％）经历了FN。在14名没有接受预防性抗生素治疗的患者中，四个人患有4级中性粒细胞减少症,包括两名开发FN的人。相反,在接受预防性左氧氟沙星的12名患者中，六人有4级中性粒细胞减少症,但未观察到FN病例。
结论：在第3天服用pegfilgrastim不足以预防由于DCF治疗引起的FN，预防性使用pegfilgrastim和抗生素可能是一种解决方案。
方法:化疗包括在第1天静脉内施用多西他赛(每天70mg/m2)和顺铂(每天70mg/m2),以及在第1-5天连续输注5-氟尿嘧啶(每天750mg/m2)。在每个治疗过程中的第3天以3.6mg的剂量给予Pegfilgrastim单次皮下注射。该方案每3周重复一次,最多三个疗程。不需要预防性抗生素，但允许医生酌情给予。主要终点是FN的发生率。
结果：26名患者在第3天联合给予DCF和pegfilgrastim。在DCF的第一个疗程之后，26例患者中有10例（38.5％）经历了4级中性粒细胞减少症，和两名患者（7.7％）经历了FN。在14名没有接受预防性抗生素治疗的患者中，四个人患有4级中性粒细胞减少症,包括两名开发FN的人。相反,在接受预防性左氧氟沙星的12名患者中，六人有4级中性粒细胞减少症,但未观察到FN病例。
结论：在第3天服用pegfilgrastim不足以预防由于DCF治疗引起的FN，预防性使用pegfilgrastim和抗生素可能是一种解决方案。
