Chemoradiotherapy, neutropneia and myeloid Growth factors – pro
enia during concurrent chemotherapy and radiotherapy is strongly associated with the development of acute dysphagia. G-CSF use with cCTRT for cell lung cancer is common, and studies suggest that the use of G-CSF was not associated with toxic deaths or worse survival outcomes.
While the combination of CSFs and radiotherapy was blamed for producing toxicity in the past—especially with concurrent chemotherapy—its therapeutic index should be reassessed with modern radiotherapy techniques and chemotherapy regimens. The few modern data available about G-CSFs tends to prove otherwise. Further investigations are required in order to confirm the safety of the association, especially with GM-CSFs. Once the safety concerns are out of the way, the immune benefit of concurrent CSFs and radiotherapy could be fully explored. Indeed, pre-clinical suggested that the combination of G-CSF with radiotherapy could enhance the immune antitumour response mediated by neutrophils. Clinical data suggested that GM-CSF combined with radiotherapy could trigger abscopal effect.
F. Gomes et al, Safety of G-CSF with concurrent chemo-radiotherapy in limited-stage small cell lung cancer – Secondary analysis of the randomised phase 3 CONVERT trial. Lung Cancer Volume 153, March 2021, Pages 165-170
De Ruysscher, D. et al., Maximal neutropenia during chemotherapy and radiotherapy is significantly associated with the development of acute radiation-induced dysphagia in lung cancer patients. Annals of Oncology, Volume 18, Issue 5, 909 – 916https://www.sciencedirect.com/journal/lung-cancer
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