title: Impact of granulocyte colony-stimulating factors in metastatic colorectal cancer patients.
abstract: BACKGROUND
  Delays in chemotherapy because of neutropenia may be associated with poorer outcomes. The purpose of the present study was to examine the effect that granulocyte colony-stimulating factors (g-csfs) have on survival.
  
  
  METHODS
  We conducted a chart review of all outpatients diagnosed with metastatic colorectal cancer and treated with folfiri chemotherapy (irinotecan, 5-fluorouracil, leucovorin) with or without bevacizumab at Mount Sinai Hospital between 2007 and 2012. Multivariable Cox proportional hazards models were used to compare survival in neutropenic patients treated with g-csf, in neutropenic patients not so treated, and in patients without neutropenia.
  
  
  RESULTS
  The review identified 93 patients, 31 of whom did not experience a neutropenic event. Of the 62 who experienced neutropenia, 18 were managed with g-csf support, and 44, with reductions or delays in dose. Compared with patients experiencing a neutropenic episode not treated with g-csf, those treated with g-csf experienced a nonsignificant increase in time to event [progression or death: hazard ratio (hr): 1.37; 95% confidence limits (cl): 0.72, 2.61], but compared with patients not having a neutropenic episode, the same patients experienced a significant increase in time to event (hr: 2.07; 95% cl: 1.03, 4.15).
  
  
  CONCLUSIONS
  In patients who experienced neutropenia, g-csf did not have a statistically significant impact on survival. Time to event was prolonged in g-csf-treated patients compared with patients who did not experience neutropenia.
authors: Department of Pharmacy, Mount Sinai Hospital, Toronto, ON.
authors: A
authors: A
authors: Amadio
authors: Department of Oncology, Mount Sinai Hospital, Toronto, ON.
authors: R
authors: R
authors: Burkes
authors: Department of Pharmacy, Mount Sinai Hospital, Toronto, ON.
authors: T
authors: T
authors: Bailie
authors: Department of Pharmacy, Mount Sinai Hospital, Toronto, ON.
authors: M
authors: M
authors: McLean
authors: Department of Pharmacy, Mount Sinai Hospital, Toronto, ON.
authors: B
authors: B
authors: Coleman
keywords: Colorectal cancer; g-csf; metastasis; neutropenia; progression; survival