1554P - Trends in G-CSF use in geriatric oncology: 2011 AFSOS SOFOG survey

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Supportive Care
Geriatric Oncology
Presenter Claire Falandry
Authors C. Falandry1, I. Krakowski2, H. Curé3, E. Carola4, P. Soubeyran5, O. Guérin6, G. Freyer7
  • 1Geriatrics, CHU Lyon Sud, 69495 - Pierre Bénite/FR
  • 2Service D'oncologie Médicale, Centre Alexis Vautrin, Vandoeuvre-les-Nancy/FR
  • 3Oncologie Médicale, Institut Jean Godinot, 51000 - Reims/FR
  • 4Oncologie Médicale, CH Senlis, 60300 - Senlis/FR
  • 5Department Of Medical Oncology, Institut Bergonié and Université Bordeaux Segalen, 33000 - Bordeaux/FR
  • 6Gériatrie, CHU Nice, 06000 - Nice/FR
  • 7Oncologie Médicale, CHU Lyon Sud, 69000 - Lyon/FR

Abstract

Background

Age is a risk factor for chemo-induced febrile neutropenia (FN). According international guidelines, it should be considered when discussing G-CSF use for regimens with FN risk between 10% and 20%. Prophylactic G-CSF remains controversial for regimens with a lower risk.

Patients and methods

A survey was undertaken in France to describe current treatment practices in patients aged 70 years and older with gynaecologic cancer. Individual data from 791 chemo-treated patients were collected (breast 74%, ovary 21%, uterus 5%, adjuvant 30%).

Results

According 101 practitioners, important factors to be considered for GCSF use are previous FN /neutropenic events (96%), bone radiotherapy (92%) or chemotherapy (86%), comorbidities (91%), performance status (PS) ≥2 (87%), recent septic event (92%), anemia (54%). In routine practice, GCSF was prescribed in 51% of the cases, ie 41% and 9% as primary and secondary prevention respectively and 0.4% in curative setting. Prophylactic GCSF prescription rates for regimens with FN risk ≥20%, 10-20% and <10% were 90%, 59% and 36%, respectively. Covariates associated with an increased GCSF use were: adjuvant setting (Hazard Ratio [HR] = 1.6, p = 0.007), 3 or 4-weekly regimens (HR = 2.5, p < 0.001). Physicians performing geriatric assessments were more prone to prescribe GCSF (HR = 1.5, p = 0.015), notably those involved in a comprehensive geriatric assessment network ((HR = 1.5, p = 0.007). However proven risk factors for FN were rarely considered: PS ≥2 (HR = 0.7, p = 0.05), comorbidities (HR = 1.3, p = 0.2), anemia < 12g/dL (HR = 1.0, p = 0.8), malnutrition (albumin < 35g/L, HR = 0.7, p = 0.03). In metastatic disease, previous FN (HR = 2.6, p < 0.001), or chemotherapy (HR = 1.9, p < 0.001) were significantly associated with higher rates of prophylactic GCSF, but not previous irradiation (HR = 1.1, p = 0.5); a limited number of daily G-CSF injections were given in most cases (mean: 4.9, 64% patients).

Conclusion

Our study suggests a trend to overtreatment in some cases, in comparison to international guidelines, and insufficient use of validated risk factors in treatment decision making.

Disclosure

C. Falandry: membership on an advisory board Chugaï,

I. Krakowski: membership on an advisory board Chugaï,

H. Curé: membership on an advisory board Chugaï,

E. Carola: membership on an advisory board Chugaï,

P. Soubeyran: membership on an advisory board Chugaï,

O. Guérin: membership on an advisory board Chugaï,

G. Freyer: membership on an advisory board Chugaï