Efficacy and safety of G-CSF prophylaxis in patients with extensive-stage small cell lung cancer receiving Chemoimmunotherapy

ABSTRACT

Objectives

We aimed to evaluate the efficacy and safety of granulocyte-colony stimulating factor (G-CSF) prophylaxis during chemoimmunotherapy with carboplatin plus etoposide and atezolizumab in extensive-stage small cell lung cancer (ES-SCLC).

Methods

This retrospective, multicenter study enrolled ES-SCLC patients receiving carboplatin plus etoposide and atezolizumab, categorized into G-CSF and non-G-CSF groups. Demographic and disease-related data were collected. Response rates, progression-free survival (PFS), overall survival (OS), and toxicity were analyzed.

Results

Of 119 patients (median age: 63 years), the overall response rate (ORR) and disease control rate (DCR) were 72.3% and 81.5%, respectively. In the G-CSF group, the ORR was 76.4% compared to 60.0% in the non-G-CSF group (p = 0.33), and the DCR was 85.4% versus 70.0%, respectively (p = 0.46). Median PFS was 8.3 months (95% CI, 6.8-9.8) in the G-CSF group and 6.8 months (95% CI, 6.2-7.5) in the non-G-CSF group (p = 0.24). Median OS was 13.8 months (95% CI, 9.6-18.1) for the G-CSF group and 10.6 months (95% CI, 7.9-13.3) for the non-G-CSF group (p = 0.47). Grade 3 ≥ adverse events were similar between groups (49.4% vs. 33.3%, respectively, p = 0.12).

Conclusion

G-CSF prophylaxis can be safely used in ES-SCLC patients undergoing carboplatin plus etoposide and atezolizumab regimen without significantly altering efficacy or increasing toxicity.

KEYWORDS:

• Chemoimmunotherapy
• granulocyte-colony stimulating factor
• G-CSF
• immune check point inhibitors
• SCLC
• small cell lung cancer

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Highlights

• G-CSF prophylaxis did not significantly alter response rates in patients undergoing chemoimmunotherapy for extensive-stage SCLC.

• Progression-free survival and overall survival were not significantly different between the G-CSF and non-G-CSF groups.

• Thoracic radiotherapy emerged as an independent positive prognostic factor for both PFS and OS in patients undergoing carboplatin plus etoposid and atezolizumab for exensive-stage SCLC.

• The incidence of grade 3-4 adverse events was comparable between the G-CSF and non-G-CSF groups.

• This study represents a significant step in understanding the role of G-CSF prophylaxis in chemoimmunotherapy regimens and supports its safe use by clinicians when needed.

Decalaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

Y Ilhan and Y Ergun contributed to the study conception and design. Y Ilhan, G Ucar, MN Baser, SC Efil, B Demir, D Ercan Uzundal, T Karacelik, H Arvas, OB Ekinci, Z Urakcı, M Karakurt Eryılmaz, O Yazıcı, MA Nahit Sendur, D Uncu and Y Ergun participated in material preparation and data collection. HG Guzel, N Sever, OY Balcik, B Ozturk, I Karadag, A Kadioglu, O Kostek and C Karacin contributed to the literature review. Y Ilhan and Y Ergun were done the statistical analysis. Y Ergun, D Uncu, B Ozturk, MA Nahit Sendur, O Yazıcı conducted a critical evaluation of the article’s findings. The first draft of the manuscript was written by Y Ilhan and all authors commented on previous versions of the manuscript and on revision. All authors read and approved the final manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics Statement:

The research adhered to Good Clinical Practice guidelines and the principles outlined in the Declaration of Helsinki. Approval for the study was obtained from the Local Clinical Research Ethics Committee (Approval Date/No. 03.04.2024/E2-24-6471).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2024.2391007

Data availability statement

Data are available upon reasonable request from the corresponding author.

Table-1: Basic Demographic and Clinical Characteristics of Patients According to G-CSF Usage Status

Tablo-2: Patients’ Treatment Responses According to G-CSF Usage Status

Table-3: Univariate and Multivariate Analyses for Progression-free Survival and Overall Survival

Additional information

Funding

This paper was not funded.