Safety in the use of granulocyte-colony stimulating factor during concurrent chemotherapy and thoracic radiotherapy in patients with small-cell lung cancer: A meta-analysis.

e20124 Background: There is an ongoing debate about whether patients with small cell lung cancer (SCLC) undergoing concurrent chemoradiotherapy should receive granulocyte-colony stimulating factor (G-CSF). The main concern relies on safety issues. Therefore, we performed a systematic review and meta-analysis to assess the safety and efficacy of prophylactic G-CSF use in patients with SCLC receiving concurrent chemoradiotherapy. Methods: We systematically searched the MEDLINE, Cochrane, and EMBASE databases up to December 2023 for studies assessing prophylactic use of G-CSFs versus non-prophylactic use in SCLC undergoing concurrent chemoradiotherapy. We included randomized and non-randomized clinical trials. The main safety outcomes were thrombocytopenia, febrile neutropenia, anemia, and radiotherapy toxicity. We performed statistical analysis using RevMan 5.4.1 and pooled odds ratio (OR) and 95% confidence interval (95%CI) of binary outcomes. We defined a significant threshold as p-value 25% being defined as high heterogeneity. Results: We included five studies with a total of 774 patients, of whom 322 (42%) received G-CSF prophylactically, and 452 (58%) were in the control group. The majority of patients (97.5%) presented with Limited Stage disease. The minimum follow-up period had a median duration of 16.9 months, while the maximum follow-up extended to a median of 45 months (Table). Patients in the prophylactic group had a significantly lower incidence of neutropenia (OR: 0.34; 95% CI: 0.14-0.85; p = 0.02) than those who did not use G-CSF prophylactically. Radiotherapy toxicity (OR: 0.98; 95% CI: 0.63-1.53; p = 0.93) and severe hematological toxicity (grade III-IV) were similar in both groups. Hematological toxicity included thrombocytopenia (OR: 1.21; 95% CI: 0.32-4.58; p = 0.78), febrile neutropenia (OR: 1.11; 95% CI: 0.29-4.28; p = 0.88), and anemia (OR: 0.51; 95% CI: 0.13-1.97; p = 0.33). Conclusions: Our systematic review and meta-analysis supports the prophylactic use of G-CSF during concurrent chemoradiotherapy for patients with SCLC. Prophylactic G-CSF promoted a significant reduction in the incidence of neutropenia without any hematologic or radiotherapy-related toxicity increase. Incorporating G-CSF prophylaxis into SCLC chemoradiotherapy regimens can be a beneficial strategy for minimizing neutropenic complications without compromising overall treatment safety. Table: see text