Aim:
To investigate the incidence of Febrile Neutropenia (FN) in patients receiving chemotherapy (+/-) atezolizumab for the treatment of Small-Cell Lung Cancer (SCLC), either limited stage (LS-SCLC) or extensive stage (ES-SCLC), +/- granulocyte-colony stimulating factor (G-CSF) support.
Method:
A retrospective audit was conducted at a metropolitan hospital between 01/01/2019 and 31/05/2022 on patients receiving standard of care (SOC) treatment who were diagnosed with SCLC. Collection parameters included patient demographics, disease stage, treatment administered, and if G-CSF was administered at each cycle. FN incidence was compared between those patients who did and did not receive G-CSF.
Results:
The majority of the 137 patients completed 4 cycles of platinum-etoposide based therapy (+/- atezolizumab) with 46 patients re-challenging after the 4 initial cycles (counted as cycle 1 again). Out of all of the cycle 1 treatments (n=163), 20 patients (12%) experienced FN and were admitted to hospital. 13/20 (65%) patients with FN were not prescribed G-CSF, while 7/20 (35%) patients received G-CSF (p=0.06). For the LS-SCLC group, the use of G-CSF resulted in a statistically significant decrease in FN incidence with 1/38 patients in the-G-CSF group compared to 6/38 patients in the non-GCSF group (p=0.05). While for the ES-SCLC group, there were 6/125 and 7/125 in the G-CSF and non-G-CSF groups, respectively (p= 0.78). All patients with FN following cycle 1, had G-CSF added +/- a treatment dose reduction for subsequent cycles. FN incidence dropped to 2% on cycle 2 and remained low thereafter. There was one known fatality (limited stage SCLC) due to severe neutropenic sepsis.
Conclusion:
The addition of G-CSF to cycle 1 lowered FN incidence in patients with SCLC and was statistically significant for the LS-SCLC group. A larger study is warranted to investigate upfront G-CSF with SOC treatment is required, or at least considered for specific patient cohorts.