Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct 25;9(1):15374.
doi: 10.1038/s41598-019-51982-4.

Efficacy and tolerability of granulocyte colony-stimulating factors in cancer patients after chemotherapy: A systematic review and Bayesian network meta-analysis

Yong Wang  1   2 , Lin Chen  3 , Fen Liu  4 , Ning Zhao  4 , Liyao Xu  5 , Biqi Fu  6 , Yong Li  7
Affiliations

Efficacy and tolerability of granulocyte colony-stimulating factors in cancer patients after chemotherapy: A systematic review and Bayesian network meta-analysis

Yong Wang et al. Sci Rep. .

Abstract

The optimum granulocyte colony-stimulating factor (G-CSF) treatment for cancer patients after being treated with cytotoxic chemotherapy remains unknown. Therefore, a systematic review and Bayesian network meta-analysis were performed to assess the efficacy and tolerability of 11 G-CSF drugs on patients after chemotherapy. A total of 73 randomized controlled trials (RCTs) containing 15,124 cancer patients were included for the final network meta-analysis. Compared with pegfilgrastim, there were a higher risk with filgrastim for incidence of febrile neutropenia (FN) (OR [95% CI]: 1.63 [1.07, 2.46]), and a higher risk with short-acting G-CSF (S-G-CSF) biosimilar and lenograstim for incidence of bone pain (BP) (OR [95% CI]: 6.45 [1.10, 65.73], 5.12 [1.14, 26.12], respectively). Mecapegfilgrastim, lipegfilgrastim and balugrastim were best G-CSF drugs in reducing FN (cumulative probabilities: 58%, 15%, 11%, respectively). S-G-CSF biosimilar, empegfilgrastim, and long-acting G-CSF (L-G-CSF) biosimilar were best G-CSF drugs in reducing severe neutropenia (SN) (cumulative probabilities: 21%, 20%, 15%, respectively). Mecapegfilgrastim, balugrastim, lipegfilgrastim and L-G-CSF biosimilar were best G-CSF drugs in reducing BP (cumulative probabilities: 20%, 14%, 8%, 8%, respectively). Mecapegfilgrastim, lipegfilgrastim and balugrastim might be the most appreciate G-CSF drugs with both good efficacy and tolerability when treating cancer patients after cytotoxic chemotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of the meta-analysis.
Figure 2
Figure 2
The network of the Bayesian network meta-analysis. Each node represents the treatment, and the size is proportional to the number of patients included. Each line represents the direct comparisons between treatments, and the width of the line is proportional to the number of randomized controlled trials.
Figure 3
Figure 3
The pooled odds ratios (ORs) for the efficacy (FN and SN) and tolerability (BP) of the 12 treatments. The ORs are the column treatments compared with the row treatments in efficacy (FN and SN), and the row treatments compared with the column treatments in tolerability (BP). The results of efficacy (FN and SN) are in blue and orange, and the results of tolerability (BP) are in green. The first line of efficacy (FN and SN) in blue is the OR of FN, while the second line in orange is the OR of SN. The numbers in bold indicate the significant results. -, not compared.
Figure 4
Figure 4
The ranking of treatments for efficacy (FN and SN) and tolerability (BP).
See this image and copyright information in PMC

References

    1. Crawford J, et al. Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: the results of a prospective nationwide study of oncology practice. J Natl Compr Canc Netw. 2008;6:109–118. doi: 10.6004/jnccn.2008.0012. - DOI - PubMed
    1. Rossi L, et al. Efficacy and safety analysis of once per cycle pegfilgrastim and daily lenograstim in patients with breast cancer receiving adjuvant myelosuppressive chemotherapy FEC 100: a pilot study. Ther Clin Risk Manag. 2013;9:457–462. doi: 10.2147/TCRM.S48387. - DOI - PMC - PubMed
    1. Pettengell R, Schwenkglenks M, Bosly A. Association of reduced relative dose intensity and survival in lymphoma patients receiving CHOP-21 chemotherapy. Ann Hematol. 2008;87:429–430. doi: 10.1007/s00277-008-0447-2. - DOI - PMC - PubMed
    1. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106:2258–2266. doi: 10.1002/cncr.21847. - DOI - PubMed
    1. Smith TJ, et al. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. 2006;24:3187–3205. doi: 10.1200/JCO.2006.06.4451. - DOI - PubMed

Publication types

Substances