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Effectiveness of G-CSF in chemotherapy for digestive system tumors: a systematic review of the Clinical Practice Guidelines for the Use of G-CSF 2022 delineated by the Japan Society of Clinical Oncology

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Abstract

Background

Granulocyte colony-stimulating factor (G-CSF) reportedly reduces the risk of neutropenia and subsequent infections caused by cancer chemotherapy. Although several guidelines recommend using G-CSF in primary prophylaxis according to the incidence rate of chemotherapy-induced febrile neutropenia (FN), the effectiveness of G-CSF in digestive system tumor chemotherapy remains unclear. To address these clinical questions, we conducted a systematic review as part of revising the Clinical Practice Guidelines for the Use of G-CSF 2022 published by the Japan Society of Clinical Oncology.

Methods

This systematic review addressed two main clinical questions (CQ): CQ1: “Is primary prophylaxis with G-CSF effective in chemotherapy?”, and CQ2: “Is increasing the intensity of chemotherapy with G-CSF effective?” We reviewed different types of digestive system tumors, including esophageal, gastric, pancreatic, biliary tract, colorectal, and neuroendocrine carcinomas. PubMed, Cochrane Library, and Ichushi-Web databases were searched for information sources. Independent systematic reviewers conducted two rounds of screening and selected relevant records for each CQ. Finally, the working group members synthesized the strength of evidence and recommendations.

Results

After two rounds of screening, 5/0/3/0/2/0 records were extracted for CQ1 of esophageal/gastric/pancreatic/biliary tract/colorectal/ and neuroendocrine carcinoma, respectively. Additionally, a total of 2/6/1 records were extracted for CQ2 of esophageal/pancreatic/colorectal cancer, respectively. The strength of evidence and recommendations were evaluated for CQ1 of colorectal cancer; however, we could not synthesize recommendations for other CQs owing to the lack of records.

Conclusion

The use of G-CSF for primary prophylaxis in chemotherapy for colorectal cancer is inappropriate.

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Acknowledgements

This guideline and systematic review were led by the Japanese Society of Clinical Oncology (JSCO). The authors thank Mr. Naohiko Yamaguchi and Ms. Yuko Mitsuoka for the initial record search and Professor Masahiro Yoshida of the Minds Tokyo GRADE Center for imparting knowledge about the systematic review methodology. We would also like to thank Ms. Natsuki Fukuda for her efforts in managing the project and formulating the guidelines.

Author information

Authors and Affiliations

  1. Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Mamoru Ito & Kenji Tsuchihashi

  2. Department of Gastrointestinal and Medical Oncology, NHO Kyushu Cancer Center, Fukuoka, Japan

    Yuta Okumura

  3. Department of Medical Oncology, Hamanomachi Hospital, Fukuoka, Japan

    Kenta Nio

  4. Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Eishi Baba

  5. Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Yukinori Ozaki & Toshimi Takano

  6. Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan

    Hiroshi Nishio

  7. Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan

    Eiki Ichihara

  8. Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan

    Yuji Miura

  9. Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan

    Makoto Endo

  10. Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano

  11. Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Dai Maruyama

  12. Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Tetsuhiro Yoshinami

  13. Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, Japan

    Nobuyuki Susumu

  14. Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan

    Munetaka Takekuma

  15. Department of Obstetrics and Gynecology, Tokyo Women’s Medical University Hospital, Tokyo, Japan

    Takashi Motohashi

  16. Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan

    Nobuaki Ochi

  17. Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan

    Toshio Kubo

  18. Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan

    Keita Uchino

  19. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan

    Takahiro Kimura

  20. Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan

    Yutaro Kamiyama

  21. Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan

    Shinji Nakao

  22. Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan

    Shinobu Tamura

  23. Department of Nursing, Okayama University Hospital, Okayama, Japan

    Hitomi Nishimoto

  24. Department of Drug Information, Faculty of Pharmaceutical Sciences, Shonan University of Medical Sciences, Kanagawa, Japan

    Yasuhisa Kato

  25. Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Aomori, Japan

    Atsushi Sato

Authors
  1. Mamoru Ito
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  2. Yuta Okumura
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  3. Kenta Nio
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  4. Eishi Baba
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  5. Yukinori Ozaki
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  6. Hiroshi Nishio
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  7. Eiki Ichihara
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  8. Yuji Miura
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  9. Makoto Endo
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  10. Shingo Yano
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  11. Dai Maruyama
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  12. Tetsuhiro Yoshinami
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  13. Nobuyuki Susumu
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  14. Munetaka Takekuma
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  15. Takashi Motohashi
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  16. Nobuaki Ochi
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  17. Toshio Kubo
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  18. Keita Uchino
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  19. Takahiro Kimura
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  20. Yutaro Kamiyama
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  21. Shinji Nakao
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  22. Shinobu Tamura
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  23. Hitomi Nishimoto
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  24. Yasuhisa Kato
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  25. Atsushi Sato
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  26. Toshimi Takano
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  27. Kenji Tsuchihashi
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Contributions

Conceptualization: T. T. and K. T.; Formal analysis: M. I., Y. O., K. N., E. B., and K. T.; Investigation: M. I., Y. O., K. N., E. B., and K. T.; Data curation: M. I., Y. O., K. N., E. B., and K. T.; Writing—original draft preparation: M. I.; Writing—review and editing: Y. O., K. N., E. B., and K. T.; Visualization: M. I.; Supervision: all authors. Project administration: T. T. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Kenji Tsuchihashi.

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Conflict of interest

Eishi Baba received honoraria from Chugai Pharmaceutical Co., Ltd. and Daiichi Sankyo Co., Ltd., and research funding from Taiho Pharmaceutical Co., Ltd. and Chugai Pharmaceutical Co., Ltd. Yukinori Ozaki received honoraria from Daiichi Sankyo Co., Ltd., Pfizer Japan Inc., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., and Kyowa Kirin Co., Ltd. Eiki Ichihara received honoraria from Eli Lilly Japan K.K. and research funding from MSD K.K., Ono Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., and Takeda Pharmaceutical Co., Ltd. Yuji Miura received honoraria from Ono Pharmaceutical Co., Ltd., MSD K.K., Takeda Pharmaceutical Co., Ltd., Eisai Co., Ltd., and Bristol Myers Squibb Co., Ltd., and research funding from MSD K.K. and Ono Pharmaceutical Co., Ltd. Shingo Yano received research funding from Otsuka Pharmaceutical Co., Ltd. Dai Maruyama received honoraria from Ono Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Nippon Shinyaku Co., Ltd., Eisai Co., Ltd., Mundipharma, Kyowa Kirin Co., Ltd., Chugai Pharmaceutical Co., Ltd., Zenyaku Holdings Co., Ltd., MSD K.K., SymBio Pharmaceutical Ltd., Sanofi K.K., AbbVie Inc., Takeda Pharmaceutical Co., Ltd., AstraZeneca K.K., Bristol Myers Squibb Co., Ltd., and Genmab K.K., and research funding from Amgen K.K., Astellas Pharma Inc., Biopharma Co., Ltd., Novartis Pharmaceutical K.K., Kyowa Kirin Co., Ltd., Ono Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Sanofi K.K., Bristol Myers Squibb Co., Ltd., AbbVie Inc., Eisai Co., Ltd., MSD K.K., Taiho Pharmaceutical Co., Ltd., AstraZeneca K.K., Eli Lilly Japan K.K., and Genmab K.K. Tetsuhiro Yoshinami received honoraria from Kyowa Kirin Co., Ltd., Pfizer Japan Inc., Chugai Pharmaceutical Co., Eli Lilly Japan K.K., MSD K.K., AstraZeneca K.K., and Eisai Co., Ltd. Takashi Motohashi received honoraria from AstraZeneca K. K., Chugai Pharmaceutical Co., and Myriad Genetics G. K. Toshio Kubo has received honoraria from Chugai Pharmaceutical Co. Takahiro Kimura received honoraria from Sanofi K.K. Shinji Nakao received honoraria from Kyowa Kirin Co., Ltd. Atsushi Sato received honoraria from Chugai Pharmaceutical Co., and Taiho Pharmaceutical Co., Ltd., and received scholarship donations from Chugai Pharmaceutical Co., and Taiho Pharmaceutical Co., Ltd. Toshimi Takano received honoraria from Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co., and Eli Lilly Japan K.K. Kenji Tsuchihashi received honoraria from Ono Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Taiho Pharmaceutical Co., Ltd., and Novartis Pharmaceutical K.K.

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Ito, M., Okumura, Y., Nio, K. et al. Effectiveness of G-CSF in chemotherapy for digestive system tumors: a systematic review of the Clinical Practice Guidelines for the Use of G-CSF 2022 delineated by the Japan Society of Clinical Oncology. Int J Clin Oncol (2024). https://doi.org/10.1007/s10147-024-02502-6

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