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

Abstract

e24115 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. The aim of the current study is to describe the use of G-CSF, patients’ characteristics in real life setting and their impact on survival in patients with Small Cell LC (SCLC). Methods: We performed a secondary data analysis focused on SCLC from KBP-ESCAP-2020 studies, real-life nationwide, prospective and multicenter French cohort studies conducted in patients diagnosed with primary lung cancer (LC). FN risk was assessed according to EORTC guidelines. (Table). Results: 527 patients with SCLC were included in our analysis, 335 (63.6%) received G-CSF prophylaxis (G-CSF +). Patients in G-CSF+ group vs G-CSF - showed a younger age at diagnosis (mean 66.7 years vs 69.5 p<0.001), a better general condition, (PS 0-1 in 74.8% vs 55.1% p<0.0001), more active or ex-smokers (67.2%, 29.6% vs 62.5%, 28.6% p = 0.023). 447 (84.8%) patients with SCLC were considered at high-risk of FN>20% and received chemotherapies regimens. Among them, 318 (71.1%) received G-CSF prophylaxis and (28.9%) didn’t, while some patients not considered at high-risk of FN received G-CSF. The median survival among FN at-risk patients, was 11.0 [10.0 - 11.9] months in the G-CSF+ group vs 7.8 [6.1 - 10.8] in G-CSF- group; A better Overall Survival (OS) was shown for G-CSF+ group at 6 months 75.8% [71.2 - 80.6] vs 58.9% [51.0 - 68.0]. In multivariate analysis considering age at 65 years old as risk factors, G-CSF prophylaxis had an impact on survival benefit in patients with metastatic SCLC: HR 0.78 (0.61, 1.01), p=0.05 and in patients with PS ≥ 2 HR 0.48 (0.33, 0.72) p <0.001. Conclusions: In real life setting, prophylactic G-CSF are used in 2/3 of patients with SCLC receiving a chemotherapy regimen with high risk of FN according to guidelines. The benefit of G-CSF on survival are confirmed for the most severe patients, those at metastatic stage and PS ≥ 2. Definition of Febrile Neutropenia (FN) at-risk population in SCLC (EORTC Guidelines). R20 – High risk Chemotherapy regimens with risk of FN > 20% Etoposide in monotherapy or associated with carboplatin. Cisplatin + Etoposide Cisplatin + Etoposide + durvalumab Carboplatin + Etoposide + durvalumab Carboplatin + Etoposide + atezolizumab Topotecan R10 – Intermediate risk* Chemotherapy regimens with risk of FN between 10 and 20%Paclitaxel/carboplatin *For chemotherapy regimens associated with an intermediate risk of FN (10-20%), 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