How do you approach patients with unresectable pancreatic cancer on gemcitabine/nab-paclitaxel-based chemotherapy q28 days with severe neutropenia?

I always give gem-nab-pac every other week from the outset. So I rarely run into this issue, and when I do, it is easy, on a q2 week schedule, to add pegfilgrastim.

Cytopenias and eventually, neuropathy are the major limiting toxicities of the three on and one-off dosing schedules of Gemcitabine and Nab-Paclitaxel. Previously, data has shown that every other week dosing is less toxic, more tolerable, and has the same efficacy (Ahn et al., PMID 28203300).

We are,...