Real-life use of G-CSF in non-small cell lung cancer (NSCLC): Secondary data analysis from the French national cohorts KBP-ESCAP-2020-CPHG.

Abstract

e24119 Background: Febrile neutropenia (FN) is a frequent related side-effect in the treatment of lung cancer (LC), a common and potentially life-threatening complication of myelosuppressive chemotherapy. Granulocyte Colony Stimulating Factors (G-CSF) have proven efficacy in the prophylaxis of FN. The aim of this study is to describe the use of G-CSF, the patients’ characteristics in real life setting and the impact on survival in patients with Non-Small Cell LC (NSCLC). Methods: We performed a secondary data analysis focused on NSCLC from KBP-ESCAP-2020 studies, real-life nationwide, prospective and multicenter French cohort studies conducted in patients with LC. For each patient, we estimated FN risk using the EORTC guidelines (Table). Results: A total of 3287 patients with NSCLC were included in our analysis, 707 patients (21,5%) received G-CSF (G-CSF + group) and 2580 (78,5%) do not (G-CSF-). In G-CSF+ group, patients were younger (mean 65.2 vs 68.5 years, p<0.0001), in better general condition (PS 0-1 in 89.0 vs 74.7%, p<0.0001), with more never-smokers, (7.6 vs 14.4%, p <0.0001), and metastatic stage (65.3 vs 56.3%, p<0.0001). On the 218 patients (6.6%) considered at high-risk of FN, 84 (38.5%) received G-CSF prophylaxis. By contrast from the 3069 patients who were not considered at high-risk of FN, 619 (20,2%) patients received a G-CSF (G-CSF+). The 3 years Overall Survival (OS) was 60.2 % [50.5 - 71.8] in patients with G-CSF+ vs 60.3 [52.6 - 69.2] in G-CSF-, median survival was 39.7 [36.8 - NA] vs 43.4 [37.1 - NA]. In multivariate analysis age doesn’t appear to be a risk factor impacting survival. Conclusions: In this real-life cohort, FN prophylaxis with G-CSF was largely used in NSCLC patients considered with no high-risk of FN while less used in patients with high-risk of FN in regards of current international guidelines (EORTC). G-CSF use was more considered for young patients with good general condition. Better awareness of FN risk and its management is necessary and should be considered for all patients at FN high risk. Further analysis will be provided to better explain the study results on G-CSF use in the prophylaxis of NSCLC patients in real life. Definition of febrile neutropenia (FN) at-risk population in NSCLC (EORTC Guidelines). R20 – High risk of FN Chemotherapy regimens with rates of FN > 20% Cisplatin + Etoposide Carboplatin + Docetaxel Cisplatin + Vinorelbine + Cetuximab R10 – Intermediate risk of FN* Chemotherapy regimens with rates of FN between 10 and 20% Cisplatin + Docetaxel Cisplatin + Paclitaxel Cisplatin + Vinorelbine *for chemotherapy regimens associated with an intermediate (10–20%) risk of FN, consider additional risk factors:Age > 65 years Advanced stage disease (III and IV) Poor nutritional status and/or Performance status (PS) 3 and 4 Female gender