LBA2_PR - Use of G-CSF and prophylactic antibiotics with concurrent chemo-radiotherapy in limited-stage small cell lung cancer: Results from the Phase III CO...

Date 07 May 2017
Event ELCC 2017
Session SCLC and early stage NSCLC
Topics Small-Cell Lung Cancer
Thoracic malignancies
Surgical oncology
Therapy
Radiation oncology
Presenter Fabio Gomes
Citation Annals of Oncology (2017) 28 (suppl_2): ii69-ii70. 10.1093/annonc/mdx195
Authors F. Gomes1, C. Faivre-Finn2, F. Fernandez-Gutierrez3, D. Ryder4, A. Bezjak5, F. Cardenal6, P. Fournel7, J. Van Meerbeeck8, F. Blackhall9
  • 1Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/GB
  • 2Division Of Molecular And Clinical Cancer Sciences, University of Manchester, Manchester/GB
  • 3Clinical And Experimental Pharmachology, Cancer Research UK Manchester Institute, Manchester/GB
  • 4Manchester Academic Health Science Centre Trials Co-ordination Unit, The Christie NHS Foundation Trust, Manchester/GB
  • 5Canadian Cancer Trials Group, Princess Margaret Hospital, Toronto/CA
  • 6Gecp, Institut Català d'Oncologia Hospital Duran i Reynals, Barcelona/ES
  • 7Oncologie Medicale, Institute de Cancerologie de la Loire, St. Priest en Jarez/FR
  • 8Department Of Thoracic Oncology, Antwerp University Hospital, Edegem/BE
  • 9Medical Oncology, The Christie NHS Foundation Trust, Manchester/GB

Abstract

Background

Concurrent chemo-radiotherapy (CTRT) is the optimal treatment for limited-stage small cell lung cancer. The use of granulocyte colony stimulating-factor (G-CSF) in this context is controversial and its routine use is not recommended after a report of higher toxicity but the safety data is scarce. The use of prophylactic antibiotics is also not standardised.

Methods

In a phase 3 trial, 547 patients (pts) were randomised between once-daily RT (66Gy 33 fractions) or twice-daily (45Gy 30 fractions) with chemotherapy (cisplatin/etoposide). The use of prophylactic G-CSF and antibiotics was permitted.

Results

33% of pts received at least 1 cycle of prophylactic G-CSF and 41% received prophylactic and/or therapeutic G-CSF. Its use increased from 11% at cycle 1 to 27% at cycle 4. Prophylactic antibiotics were used in 48% of pts but its use decreased from 41% to 20%. The use of antibiotics and/or G-CSF was similar in both arms. The incidence of grade 3/4 thrombocytopenia was higher in pts with G-CSF (29.4% vs. 13%; p 

Conclusions

The use of G-CSF with modern radiotherapy techniques during CTRT does not result in an increased risk of severe acute esophagitis or pneumonitis. Despite an increased incidence of severe thrombocytopenia and anaemia, the use of G-CSF was not detrimental in PFS or OS.

Clinical trial identification

ISRCTN91927162 / NCT00433563

Legal entity responsible for the study

The Christie NHS Foundation Trust

Funding

The Christie NHS FT, Cancer Research UK, EORTC, GECP, GFPC, IFCT.

Disclosure

All authors have declared no conflicts of interest.