Efficacy and safety of dose-dense chemotherapy for early-stage breast cancer under prophylactic pegfilgrastim administration: a systematic review and meta-analysis from clinical practice guidelines for the use of G-CSF 2022.

• Tác giả: Eishi Baba, Makoto Endo, Eiki Ichihara, Mamoru Ito, Yutaro Kamiyama, Yasuhisa Kato, Takahiro Kimura, Toshio Kubo, Dai Maruyama, Yuji Miura, Takashi Motohashi, Shinji Nakao, Hitomi Nishimoto, Hiroshi Nishio, Kazuki Nozawa, Nobuaki Ochi, Yukinori Ozaki, Atsushi Sato, Nobuyuki Susumu, Toshimi Takano, Munetaka Takekuma, Shinobu Tamura, Kenji Tsuchihashi, Keita Uchino, Shingo Yano, Takamichi Yokoe, Tetsuhiro Yoshinami
• Ngôn ngữ: eng
• Thông tin xuất bản: Japan : International journal of clinical oncology , 2025
• Bộ sưu tập: NCBI
• ID: 753072

Tóm tắt

 BACKGROUND: In early-stage breast cancer, dose-dense chemotherapy, which involves the administration of standard doses at shorter intervals, is safer when administered with granulocyte colony-stimulating factor (G-CSF) to mitigate chemotherapy-induced neutropenia. This study aimed to thoroughly evaluate the advantages and disadvantages of dose-dense regimens based on the use of G-CSF. METHODS: A systematic review was conducted according to the "Minds Handbook for Clinical Practice Guideline Development" using PubMed, Ichushi-Web, and the Cochrane Library databases. Randomized controlled trials (RCTs) and cohort studies assessing dose-dense chemotherapy with prophylactic pegfilgrastim administration in early-stage breast cancer were included. Outcomes included overall survival, event-free survival, incidence of febrile neutropenia, quality of life (QOL), and pain. Meta-analyses were performed on outcomes with sufficient data. RESULTS: Our literature search identified 23 RCTs. Overall survival and event-free survival showed a trend favoring dose-dense therapy (hazard ratio, 0.90, 0.90
  95% confidence interval [CI] 0.78 - 1.03, 0.80 - 1.01
  p = 0.13
  0.07, respectively). The incidence of febrile neutropenia was similar between the groups (odds ratio, 0.90
  95% CI 0.58 - 1.40
  p = 0.65). Mortality due to infection could not be compared owing to the small number of events. Pain increased with dose-dense therapy (odds ratio 2.57
  95% CI 1.00 - 6.62
  p = 0.05), likely from G-CSF-induced bone pain. Only one study examined QOL, showing a decline with chemotherapy that recovered after treatment. CONCLUSIONS: Dose-dense chemotherapy trended toward improved survival outcomes without increasing the risk of infection, although pain increased. Further research should identify the specific subgroups that most benefit from dose-dense regimens. More data are needed on the impact on QOL.