Introduction

The timing of prophylactic pegylated granulocyte colony-stimulating factor (G-CSF) administration during cancer chemotherapy varies, with Day 2 and Days 3–5 being the most common schedules. Optimal timing remains uncertain, affecting efficacy and adverse events. This systematic review sought to evaluate the available evidence on the timing of prophylactic pegylated G-CSF administration.

Methods

Based on the Minds Handbook for Clinical Practice Guideline Development, we searched the PubMed, Ichushi-Web, and Cochrane Library databases for literature published from January 1990 to December 2019. The inclusion criteria included studies among the adult population using pegfilgrastim. The search strategy focused on timing-related keywords. Two reviewers independently extracted and assessed the data.

Results

Among 300 initial search results, only four articles met the inclusion criteria. A meta-analysis for febrile neutropenia incidence suggested a potential higher incidence when pegylated G-CSF was administered on Days 3–5 than on Day 2 (odds ratio: 1.27, 95% CI 0.66–2.46, p = 0.47), with a moderate certainty of evidence. No significant difference in overall survival or mortality due to infections was observed. The trend of severe adverse events was lower on Days 3–5, without statistical significance (odds ratio: 0.72, 95% CI 0.14–3.67, p = 0.69) and with a moderate certainty of evidence. Data on pain were inconclusive.

Conclusions

Both Day 2 and Days 3–5 were weakly recommended for pegylated G-CSF administration post-chemotherapy in patients with cancer. The limited evidence highlights the need for further research to refine recommendations.

中文翻译：

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癌症患者化疗后预防性使用聚乙二醇化 G-CSF 的最佳时机：2022 年 G-CSF 使用临床实践指南的系统回顾和荟萃分析

介绍

癌症化疗期间预防性给予聚乙二醇化粒细胞集落刺激因子 (G-CSF) 的时间各不相同，最常见的时间安排是第 2 天和第 3-5 天。最佳时机仍不确定，影响疗效和不良事件。本系统综述旨在评估有关预防性聚乙二醇化 G-CSF 给药时机的现有证据。

方法

根据《Minds Handbook for Clinical Practice Guideline Development》，我们检索了 PubMed、Ichushi-Web 和 Cochrane 图书馆数据库中 1990 年 1 月至 2019 年 12 月发表的文献。纳入标准包括在成年人中使用聚乙二醇非格司亭的研究。搜索策略侧重于与时间相关的关键词。两名评审员独立提取和评估数据。

结果

在 300 篇初步搜索结果中，只有 4 篇文章符合纳入标准。一项针对发热性中性粒细胞减少症发生率的荟萃分析表明，第 3-5 天给予聚乙二醇化 G-CSF 的发生率可能高于第 2 天（比值比：1.27，95% CI 0.66-2.46，p  = 0.47），其中中度证据的确定性。没有观察到感染引起的总生存率或死亡率存在显着差异。第 3-5 天严重不良事件的趋势较低，无统计学意义（比值比：0.72，95% CI 0.14-3.67，p  = 0.69），证据质量中等。关于疼痛的数据尚无定论。

结论

强烈建议癌症患者在化疗后第 2 天和第 3-5 天进行聚乙二醇化 G-CSF 给药。有限的证据凸显了需要进一步研究以完善建议。