Abstract：
BACKGROUND: The timing of prophylactic pegylated granulocyte colony-stimulating factor (G-CSF) administration during cancer chemotherapy varies, with Day 2 and Days 3-5 being the most common schedules. Optimal timing remains uncertain, affecting efficacy and adverse events. This systematic review sought to evaluate the available evidence on the timing of prophylactic pegylated G-CSF administration.
METHODS: Based on the Minds Handbook for Clinical Practice Guideline Development, we searched the PubMed, Ichushi-Web, and Cochrane Library databases for literature published from January 1990 to December 2019. The inclusion criteria included studies among the adult population using pegfilgrastim. The search strategy focused on timing-related keywords. Two reviewers independently extracted and assessed the data.
RESULTS: Among 300 initial search results, only four articles met the inclusion criteria. A meta-analysis for febrile neutropenia incidence suggested a potential higher incidence when pegylated G-CSF was administered on Days 3-5 than on Day 2 (odds ratio: 1.27, 95% CI 0.66-2.46, p = 0.47), with a moderate certainty of evidence. No significant difference in overall survival or mortality due to infections was observed. The trend of severe adverse events was lower on Days 3-5, without statistical significance (odds ratio: 0.72, 95% CI 0.14-3.67, p = 0.69) and with a moderate certainty of evidence. Data on pain were inconclusive.
CONCLUSIONS: Both Day 2 and Days 3-5 were weakly recommended for pegylated G-CSF administration post-chemotherapy in patients with cancer. The limited evidence highlights the need for further research to refine recommendations.
METHODS: Based on the Minds Handbook for Clinical Practice Guideline Development, we searched the PubMed, Ichushi-Web, and Cochrane Library databases for literature published from January 1990 to December 2019. The inclusion criteria included studies among the adult population using pegfilgrastim. The search strategy focused on timing-related keywords. Two reviewers independently extracted and assessed the data.
RESULTS: Among 300 initial search results, only four articles met the inclusion criteria. A meta-analysis for febrile neutropenia incidence suggested a potential higher incidence when pegylated G-CSF was administered on Days 3-5 than on Day 2 (odds ratio: 1.27, 95% CI 0.66-2.46, p = 0.47), with a moderate certainty of evidence. No significant difference in overall survival or mortality due to infections was observed. The trend of severe adverse events was lower on Days 3-5, without statistical significance (odds ratio: 0.72, 95% CI 0.14-3.67, p = 0.69) and with a moderate certainty of evidence. Data on pain were inconclusive.
CONCLUSIONS: Both Day 2 and Days 3-5 were weakly recommended for pegylated G-CSF administration post-chemotherapy in patients with cancer. The limited evidence highlights the need for further research to refine recommendations.
摘要：
背景：癌症化疗期间预防性聚乙二醇化粒细胞集落刺激因子（G-CSF）给药的时机各不相同，第2天和第3-5天是最常见的时间表。最佳时机仍然不确定，影响疗效和不良事件。本系统综述旨在评估预防性聚乙二醇化G-CSF给药时机的现有证据。
方法：基于《临床实践指南开发思想手册》，我们搜索了PubMed,Ichushi-Web,和Cochrane图书馆数据库，用于1990年1月至2019年12月出版的文献。纳入标准包括使用pegfilgrastim在成年人群中进行的研究。搜索策略侧重于与时间相关的关键字。两名审阅者独立地提取并评估数据。
结果：在300个初始搜索结果中，只有四篇文章符合纳入标准。对发热性中性粒细胞减少症发生率的荟萃分析表明，在第3-5天给予聚乙二醇化G-CSF的发生率可能高于第2天（比值比：1.27，95％CI0.66-2.46，p=0.47）。具有适度的证据确定性。没有观察到由于感染引起的总生存率或死亡率的显著差异。在第3-5天，严重不良事件的趋势较低，无统计学意义（比值比：0.72，95％CI0.14-3.67，p=0.69），并且证据具有中等确定性。关于疼痛的数据尚无定论。
结论：第2天和第3-5天都弱推荐在癌症患者化疗后给予聚乙二醇化G-CSF。有限的证据强调需要进一步研究以完善建议。
方法：基于《临床实践指南开发思想手册》，我们搜索了PubMed,Ichushi-Web,和Cochrane图书馆数据库，用于1990年1月至2019年12月出版的文献。纳入标准包括使用pegfilgrastim在成年人群中进行的研究。搜索策略侧重于与时间相关的关键字。两名审阅者独立地提取并评估数据。
结果：在300个初始搜索结果中，只有四篇文章符合纳入标准。对发热性中性粒细胞减少症发生率的荟萃分析表明，在第3-5天给予聚乙二醇化G-CSF的发生率可能高于第2天（比值比：1.27，95％CI0.66-2.46，p=0.47）。具有适度的证据确定性。没有观察到由于感染引起的总生存率或死亡率的显著差异。在第3-5天，严重不良事件的趋势较低，无统计学意义（比值比：0.72，95％CI0.14-3.67，p=0.69），并且证据具有中等确定性。关于疼痛的数据尚无定论。
结论：第2天和第3-5天都弱推荐在癌症患者化疗后给予聚乙二醇化G-CSF。有限的证据强调需要进一步研究以完善建议。
