Do you routinely utilize G-CSF as primary prophylaxis in patients receiving mFOLFIRINOX or FOLFOXIRI?

Topics: Gastrointestinal Cancers • Medical Oncology • Liver and Pancreas Tumors • Supportive Care

If so, do you avoid pegfilgrastim given that <12 days will lapse between its administration and the next cycle?

Answer from: Medical Oncologist at Academic Institution

Interesting to see the differences. I can't speak for others in our large GI practice but as we see well over 1000 pancreas cancer patients/year, there is substantial experience with FFX. I personally do not use primary prophylaxis and I/we do not routinely check DPYD. If neutropenia occurs, we add ...

Answer from: Medical Oncologist at Academic Institution

Yes. Routinely. Based on the Yale study of modified FOLFIRINOX (Stein, et al, Br J Ca: 114, 806, 2016), minor reductions in bolus and FU with peg-filgrastim reduced rate of grade 3-4 heme toxicity to 12% with only 4/74 patients having neutropenic fevers. Efficacy appeared equivalent to PRODIGE study...

Answer from: Medical Oncologist at Community Practice

At my center, we treat about 40 patients/year with modified FOLFIRINOX (no 5-FU bolus, irinotecan at 150mg/m2), and we do not use cycle 1 pegfilgrastim. Febrile neutropenia is very rare, and the addition of pegfilgrastim is also rarely required. We do use routine DPYD genotyping prior to 5-FU chemot...

Comments

Medical Oncologist at Locum Tenens
Can I ask how you go about sending DPYD testing? W...

Medical Oncologist at Mayo Clinic
Completely agree with Dr. @Gabriel A. Brooks. This...

Medical Oncologist at Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center
Hi @Daniel A. Forman - my hospital recently m...

Medical Oncologist at Locum Tenens
Thank you very much!

Answer from: Medical Oncologist at Academic Institution

Agree, regularly use at disconnect prophylactically. Given short half life of the 5FU, feel okay giving on same day of disconnect.

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