Clinical Outcomes of Secondary Prophylactic Granulocyte Colony-Stimulating Factors in Breast Cancer Patients at a Risk of Neutropenia with Doxorubicin and Cyclophosphamide-Based Chemotherapy

Choi, Jihyang; Geum, Min Jung; Kang, Ji Eun; Park, Nam Gi; Oh, Yun Kyoung; Rhie, Sandy Jeong

doi:10.3390/ph14111200

Cited by 2 publications

(1 citation statement)

References 34 publications

(56 reference statements)

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“…Secondary prophylaxis with G-CSF is a guideline-recommended strategy to prevent recurrent neutropenia [ 98 , 99 ]. Maintaining dose intensity can potentially maximise the clinical benefits of anti-cancer therapy [ 98 , 99 , 101 ]. Hence, similar to the recommendations by Bardia and colleagues from the USA, the administration of short-acting G-CSF for 2–3 days to elevate the white blood cell may allow the patient to continue T-DXd without delays [ 29 ].…”

Section: Haematological Toxicitiesmentioning

confidence: 99%

Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary Panel

Chiu¹,

Lee²,

Ho³

et al. 2023

Drug Saf

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Trastuzumab deruxtecan (T-DXd)—an antibody–drug conjugate targeting the human epidermal growth factor receptor 2 (HER2)—improved outcomes of patients with HER2-positive and HER2-low metastatic breast cancer. Guidance on monitoring and managing T-DXd–related adverse events (AEs) is an emerging unmet need as translating clinical trial experience into real-world practice may be difficult due to practical and cultural considerations and differences in health care infrastructure. Thus, 13 experts including oncologists, pulmonologists and a radiologist from the Asia-Pacific region gathered to provide recommendations for T-DXd–related AE monitoring and management by using the latest evidence from the DESTINY-Breast trials, our own clinical trial experience and loco-regional health care considerations. While subgroup analysis of Asian (excluding Japanese) versus overall population in the DESTINY-Breast03 uncovered no major differences in the AE profile, we concluded that proactive monitoring and management are essential in maximising the benefits with T-DXd. As interstitial lung disease (ILD)/pneumonitis is a serious AE, patients should undergo regular computed tomography scans, but the frequency may have to account for the median time of ILD/pneumonitis onset and access. Trastuzumab deruxtecan appears to be a highly emetic regimen, and prophylaxis with serotonin receptor antagonists and dexamethasone (with or without neurokinin-1 receptor antagonist) should be considered. Health care professionals should be vigilant for treatable causes of fatigue, and patients should be encouraged to use support groups and practice low-intensity exercises. To increase treatment acceptance, patients should be made aware of alopecia risk prior to starting T-DXd. Detailed monitoring and management recommendations for T-DXd–related AEs are discussed further. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-023-01328-x.

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Section: Haematological Toxicitiesmentioning

confidence: 99%

Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary Panel

Chiu¹,

Lee²,

Ho³

et al. 2023

Drug Saf

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Impact of antibiotic use before definitive concurrent chemoradiation in patients with locally advanced non-small cell lung cancer

Mei

et al. 2022

Strahlenther Onkol

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Purpose: The study evaluated whether antibiotic treatment before chemoradiotherapy in uenced outcomes in patients with locally advanced non-small cell lung cancer (LA-NSCLC).Methods: The records of LA-NSCLC patients treated with chemoradiotherapy between 2010 and 2017 at xxx were retrospectively examined together with their antibiotic use (antibiotic type, duration of treatment, and time between discontinuation and chemoradiotherapy). The in uence of antibiotics on progressionfree survival (PFS) and overall survival (OS) was evaluated with Kaplan-Meier curves and univariate and multivariate Cox regression.Results: Of 522 patients, 176 had received intravenous broad-spectrum antibiotics in the month before chemoradiotherapy. Antibiotic use was linked to both reduced PFS (7.9 vs. 13.4 mo, p<0.001) and OS (20.4 vs. 25.3 mo, p=0.049). Multivariate regression demonstrated that antibiotic treatment was an unfavorable independent prognostic factor for LA-NSCLC patients that received chemoradiotherapy (HR, 1.234; 95% CI, 1.019-1.494; p=0.031). Prognosis was also in uenced by the antibiotic type, length of treatment, and interval between discontinuation and start of chemoradiotherapy initiation. β-lactamase inhibitors were found to be the most harmful (median OS for β-lactamase inhibitors /Fluoroquinolones / Cephalosporins:16.5/19.9/25.9 mo, p=0.045). Cutoff values for interval and duration calculated by the Xtile procedure showed that intervals of 7-16 days or durations ≤6 days did not signi cantly affect OS relative to untreated patients (intervals: p=0.9, duration: p=0.93).Conclusions: Antibiotic treatment for longer than six days, especially with β-lactamase inhibitors, was associated with poor prognosis. Furthermore, delaying chemoradiotherapy for 7-16 days after antibiotic discontinuation may reduce these negative effects.

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Clinical Outcomes of Secondary Prophylactic Granulocyte Colony-Stimulating Factors in Breast Cancer Patients at a Risk of Neutropenia with Doxorubicin and Cyclophosphamide-Based Chemotherapy

Cited by 2 publications

References 34 publications

Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary Panel

Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary Panel

Impact of antibiotic use before definitive concurrent chemoradiation in patients with locally advanced non-small cell lung cancer

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