The rate of neutropenic sepsis in neo-adjuvant FLOT patients and the effect of adding prophylactic GCSF (Granulocyte-Colony Stimulating Factor) to our protocol


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Apini Patel1
1UCLH

Abstract

Background

Neo-adjuvant FLOT (docetaxel, oxaliplatin and fluorouracil) is considered first line treatment or resectable gastric or gastroesophageal adenocarcinoma (GEJ). The FLOT41 trial showed only 2% of patients experienced febrile neutropenia and no prophylactic GCSF was used. We investigated the rate of neutropenic sepsis in patients being treated with FLOT at University College London Hospital (UCLH) and whether adding prophylactic GCSF to our protocol was beneficial.

Method

Data was electronically extracted from Chemocare®, EPIC® and PIMS® between 2015-2019. The following parameters were collected; low neutrophil count, chemotherapy dose delay or reduction, duration of hospital admission and reason, if any delay to surgery and the GCSF dose prescribed (prior to formal addition to protocol).

Results

A total of 15 patients were found to be treated between 2015-2019. Of this sample, 2 patients were excluded as they only completed 1 cycle due to other complications related to the cancer. 7 patients were treated with FLOT before the addition of prophylactic GCSF was added from day 5 for 5 days; 8 patients were treated onwards from this change. 

 

No. of patients with:

Low neutrophils (grade 3/4)

Febrile neutropenia

Dose delay

Dose reduction

Delay to surgery

No. of patients BEFORE addition of prophylactic GCSF (n=7)

2

3

4

1

1

No. of patients AFTER addition of prophylactic GCSF (n=8)

0

0

1

0

0

Conclusion

The addition of GCSF to our FLOT protocol reduced neutropenic sepsis rates to 0 in the cohort of patients treated at UCLH. Whilst the febrile neutropenia from FLOT41 are not reflected in our cohort’s result, the percentage of G3/4 neutropenia was. The 3 patients with febrile neutropenia were admitted to hospital with an average stay of 8 days, thus highlighting the cost-benefit to prophylactic GCSF in the FLOT regimen.

1)10.1200/JCO.2017.35.15_suppl.4004 Journal of Clinical Oncology 35, no. 15_suppl (May 20 2017) 4004-4004