Clinical utility of pegfilgrastim on day 3 of preoperative docetaxel, cisplatin and 5-fluorouracil chemotherapy in elderly patients with resectable esophageal cancer

Abstract

Abstract Background Preoperative docetaxel, cisplatin, and 5-fluorouracil (DCF) has become the standard treatment for resectable esophageal squamous cell carcinoma (ESCC) based on the results of the JCOG1109 trial. However, preoperative DCF is associated with a high frequency of febrile neutropenia (FN), especially in elderly patients with risk factors for FN. The utility of primary prophylactic pegfilgrastim (PPP) on day 3 of preoperative DCF for preventing FN was demonstrated in a Phase II study, but it did report comparison data in elderly ESCC patients. We aimed to evaluate the utility of PPP in these patients. Methods We retrospectively evaluated the clinical utility of PPP on day 3 of preoperative DCF in elderly patients with resectable ESCC. The patients were divided into a day 3 pegfilgrastim group (D3PG) and a no pegfilgrastim group (NPG). The incidence of FN and grade ≥ 3 neutropenia, histopathological effects, and relapse-free survival (RFS) were compared between the groups. Results Thirty patients were enrolled in each group. FN was observed in 3.3% of patients in the D3PG and 26.6% of those in the NPG (p = 0.026), and grade ≥ 3 neutropenia was observed in 10% and 70%, respectively (p < 0.001). The pathological complete response rate was 24.1% in the D3PG and 33.3% in the NPG (p = 0.436); the respective 3-year RFS rates were 70.1% and 57.1% (p = 0.304). Conclusion PPP on day 3 of preoperative DCF significantly reduced the risks of FN and grade ≥ 3 neutropenia in elderly patients with ESCC. There was no significant difference between the groups in histological effects or RFS.