Frontiers in immunology · 2026
Granulocyte colony-stimulating factor use does not impair efficacy of chemoimmunotherapy in advanced non-small cell lung cancer: a real-world retrospective study.
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Yang Rui, Xia Handai, Zhang Ying, Ma Xinchun, Sun Xuan, Wang Zixu, Liu Ni, Zhang Mingzhen, Wang Xiuwen, Liu Yanguo
Аннотация
INTRODUCTION: Granulocyte colony-stimulating factor (G-CSF) is routinely used to manage chemotherapy-induced neutropenia in patients receiving chemoimmunotherapy for advanced non-small cell lung cancer (NSCLC). However, its potential to promote immunosuppressive tumor-associated neutrophils (TANs) has raised theoretical concerns about compromising the efficacy of immune checkpoint inhibitors (ICIs). We aimed to evaluate the real-world association between G-CSF use and survival outcomes in this setting.
METHODS: In this retrospective cohort study, we analyzed data from patients with unresectable, locally advanced or metastatic NSCLC who initiated first- or later-line chemoimmunotherapy at a tertiary academic center between 2018 and 2021. Multivariable Cox regression and inverse probability of treatment weighting (IPTW) were used to adjust for key prognostic confounders.
RESULTS: Among 120 enrolled patients, 57 (47.5%) received G-CSF during treatment. With a median follow-up of 22.6 months, the median progression-free survival (PFS) was 12.9 months in the G-CSF group versus 9.6 months in the non-G-CSF group (hazard ratio [HR] = 0.97, 95% CI: 0.60-1.58; P = 0.92). The median overall survival (OS) was 17.6 versus 15.3 months, respectively (HR = 0.99, 95% CI: 0.50-1.98; P = 0.99). In multivariable analysis, G-CSF administration was not independently associated with PFS (adjusted HR [aHR] = 1.08, 95% CI: 0.60-1.93; P = 0.80) or OS (aHR = 1.96, 95% CI: 0.80-4.78; P = 0.14). IPTW-adjusted analyses confirmed these null associations (PFS: HR = 1.30, P = 0.85; OS: HR = 1.00, P = 0.95).
DISCUSSION: In this real-world cohort, no statistically significant association between G-CSF use and survival outcomes was observed among patients with advanced NSCLC treated with chemoimmunotherapy. Further prospective studies are warranted to better define the potential risks and benefits of G-CSF in this setting, particularly regarding its long-term association with survival outcomes.
METHODS: In this retrospective cohort study, we analyzed data from patients with unresectable, locally advanced or metastatic NSCLC who initiated first- or later-line chemoimmunotherapy at a tertiary academic center between 2018 and 2021. Multivariable Cox regression and inverse probability of treatment weighting (IPTW) were used to adjust for key prognostic confounders.
RESULTS: Among 120 enrolled patients, 57 (47.5%) received G-CSF during treatment. With a median follow-up of 22.6 months, the median progression-free survival (PFS) was 12.9 months in the G-CSF group versus 9.6 months in the non-G-CSF group (hazard ratio [HR] = 0.97, 95% CI: 0.60-1.58; P = 0.92). The median overall survival (OS) was 17.6 versus 15.3 months, respectively (HR = 0.99, 95% CI: 0.50-1.98; P = 0.99). In multivariable analysis, G-CSF administration was not independently associated with PFS (adjusted HR [aHR] = 1.08, 95% CI: 0.60-1.93; P = 0.80) or OS (aHR = 1.96, 95% CI: 0.80-4.78; P = 0.14). IPTW-adjusted analyses confirmed these null associations (PFS: HR = 1.30, P = 0.85; OS: HR = 1.00, P = 0.95).
DISCUSSION: In this real-world cohort, no statistically significant association between G-CSF use and survival outcomes was observed among patients with advanced NSCLC treated with chemoimmunotherapy. Further prospective studies are warranted to better define the potential risks and benefits of G-CSF in this setting, particularly regarding its long-term association with survival outcomes.