The effects of GCSF primary prophylaxis on survival outcomes and toxicity in patients with advanced non-small cell lung cancer on first-line chemoimmunotherapy: a sub-analysis of the spinnaker study
The effects of GCSF primary prophylaxis on survival outcomes and toxicity in patients with advanced non-small cell lung cancer on first-line chemoimmunotherapy: a sub-analysis of the spinnaker study
GCSF prophylaxis is recommended in patients on chemotherapy with a >20% risk of febrile neutropenia and is to be considered if there is an intermediate risk of 10−20%. GCSF has been suggested as a possible adjunct to immunotherapy due to increased peripheral neutrophil recruitment and PD-L1 expression on neutrophils with GCSF use and greater tumour volume decrease with higher tumour GCSF expression. However, its potential to increase neutrophil counts and, thus, NLR values, could subsequently confer poorer prognoses on patients with advanced NSCLC. This analysis follows on from the retrospective multicentre observational cohort Spinnaker study on advanced NSCLC patients. The primary endpoints were OS and PFS. The secondary endpoints were the frequency and severity of AEs and irAEs. Patient information, including GCSF use and NLR values, was collected. A secondary comparison with matched follow-up duration was also undertaken. Three hundred and eight patients were included. Median OS was 13.4 months in patients given GCSF and 12.6 months in those not (p = 0.948). Median PFS was 7.3 months in patients given GCSF and 8.4 months in those not (p = 0.369). A total of 56% of patients receiving GCSF had Grade 1−2 AEs compared to 35% who did not receive GCSF (p = 0.004). Following an assessment with matched follow-up, 41% of patients given GCSF experienced Grade 1−2 irAEs compared to 23% of those not given GCSF (p = 0.023). GCSF prophylaxis use did not significantly affect overall or progression-free survival. Patients given GCSF prophylaxis were more likely to experience Grade 1−2 adverse effects and Grade 1−2 immunotherapy-related adverse effects.
Carcinoma, Non-Small-Cell Lung/pathology, Drug-Related Side Effects and Adverse Reactions, Humans, Immunotherapy/adverse effects, Lung Neoplasms/pathology, Progression-Free Survival, Retrospective Studies
Anpalakhan, Shobana
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Huddar, Prerana
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Behrouzi, Roya
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Signori, Alessio
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Cave, Judith
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Comins, Charles
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Cortellini, Alessio
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Addeo, Alfredo
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Escriu, Carles
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McKenzie, Hayley
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Barone, Gloria
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Murray, Lisa
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Bhatnagar, Gagan
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Pinato, David J
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Ottensmeier, Christian
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Gomes, Fabio
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Banna, Giuseppe Luigi
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16 January 2023
Anpalakhan, Shobana
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Huddar, Prerana
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Behrouzi, Roya
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Signori, Alessio
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Cave, Judith
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Comins, Charles
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Cortellini, Alessio
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Addeo, Alfredo
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Escriu, Carles
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McKenzie, Hayley
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Barone, Gloria
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Murray, Lisa
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Bhatnagar, Gagan
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Pinato, David J
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Ottensmeier, Christian
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Gomes, Fabio
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Banna, Giuseppe Luigi
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Anpalakhan, Shobana, Huddar, Prerana, Behrouzi, Roya, Signori, Alessio, Cave, Judith, Comins, Charles, Cortellini, Alessio, Addeo, Alfredo, Escriu, Carles, McKenzie, Hayley, Barone, Gloria, Murray, Lisa, Bhatnagar, Gagan, Pinato, David J, Ottensmeier, Christian, Gomes, Fabio and Banna, Giuseppe Luigi
(2023)
The effects of GCSF primary prophylaxis on survival outcomes and toxicity in patients with advanced non-small cell lung cancer on first-line chemoimmunotherapy: a sub-analysis of the spinnaker study.
International Journal of Molecular Sciences, 24 (2), [1746].
(doi:10.3390/ijms24021746).
Abstract
GCSF prophylaxis is recommended in patients on chemotherapy with a >20% risk of febrile neutropenia and is to be considered if there is an intermediate risk of 10−20%. GCSF has been suggested as a possible adjunct to immunotherapy due to increased peripheral neutrophil recruitment and PD-L1 expression on neutrophils with GCSF use and greater tumour volume decrease with higher tumour GCSF expression. However, its potential to increase neutrophil counts and, thus, NLR values, could subsequently confer poorer prognoses on patients with advanced NSCLC. This analysis follows on from the retrospective multicentre observational cohort Spinnaker study on advanced NSCLC patients. The primary endpoints were OS and PFS. The secondary endpoints were the frequency and severity of AEs and irAEs. Patient information, including GCSF use and NLR values, was collected. A secondary comparison with matched follow-up duration was also undertaken. Three hundred and eight patients were included. Median OS was 13.4 months in patients given GCSF and 12.6 months in those not (p = 0.948). Median PFS was 7.3 months in patients given GCSF and 8.4 months in those not (p = 0.369). A total of 56% of patients receiving GCSF had Grade 1−2 AEs compared to 35% who did not receive GCSF (p = 0.004). Following an assessment with matched follow-up, 41% of patients given GCSF experienced Grade 1−2 irAEs compared to 23% of those not given GCSF (p = 0.023). GCSF prophylaxis use did not significantly affect overall or progression-free survival. Patients given GCSF prophylaxis were more likely to experience Grade 1−2 adverse effects and Grade 1−2 immunotherapy-related adverse effects.
Text
ijms-24-01746
- Version of Record
More information
Accepted/In Press date: 9 January 2023
Published date: 16 January 2023
Additional Information:
Funding Information:
Alessio Cortellini would like to acknowledge the support provided by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC). David J Pinato would like to acknowledge the support received from Wellcome Trust Strategic Fund (PS3416) and from the Associazione Italiana per la Ricerca sul Cancro (AIRC MFAG Grant ID 25697). He also acknowledges the support of the NIHR Imperial Biomedical Research Centre (BRC), the Imperial Experimental Cancer Medicine Centre (ECMC) and the Imperial College Tissue Bank.
Keywords:
Carcinoma, Non-Small-Cell Lung/pathology, Drug-Related Side Effects and Adverse Reactions, Humans, Immunotherapy/adverse effects, Lung Neoplasms/pathology, Progression-Free Survival, Retrospective Studies
Identifiers
Local EPrints ID: 477170
URI: http://eprints.soton.ac.uk/id/eprint/477170
ISSN: 1422-0067
PURE UUID: 802081ec-f159-42be-8f2a-cc8b045a6e80
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Date deposited: 31 May 2023 16:36
Last modified: 17 Mar 2024 02:03
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Contributors
Author:
Shobana Anpalakhan
Author:
Prerana Huddar
Author:
Roya Behrouzi
Author:
Alessio Signori
Author:
Judith Cave
Author:
Charles Comins
Author:
Alessio Cortellini
Author:
Alfredo Addeo
Author:
Carles Escriu
Author:
Hayley McKenzie
Author:
Gloria Barone
Author:
Lisa Murray
Author:
Gagan Bhatnagar
Author:
David J Pinato
Author:
Fabio Gomes
Author:
Giuseppe Luigi Banna
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