Prophylactic PEG-rhG-CSF During cCRT in LA-NSCLC

Completed

• Conditions: Stage II-III Non-small Cell Lung Cancer; Concurrent Chemotherapy; Conditions Influencing Health Status

• Registration Number: NCT06958614
• Lead Sponsor: Cancer Institute and Hospital, Chinese Academy of Medical Sciences

Brief Summary

Objective: To evaluate the efficacy and safety of prophylactic use of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) during definitive concurrent chemoradiotherapy (cCRT) in patients with inoperable stage II-III non-small cell lung cancer (NSCLC).

Methods: A prospective observational cohort study was conducted on patients receiving definitive cCRT. The radiation therapy technique uses intensity modulated radiation therapy (IMRT) and involves field irradiation. It protects more normal tissue from exposure.Chemotherapy regimens included platinum-based doublet combinations: etoposide plus cisplatin (every 28 days), pemetrexed plus platinum (every 21 days), or paclitaxel plus platinum (weekly, only for control group) .

Patients were followed up at one month post-treatment, then every three months for the two year, and every six months thereafter until disease progression.

In the study group, patients received subcutaneous injections of PEG-rhG-CSF (6 mg for patients weighing ≥45 kg, 3 mg for patients \<45 kg) 48 hours after each chemotherapy cycle during cCRT. In the control group, patients received guideline-based supportive treatment. Radiotherapy was halted or chemotherapy was delayed when grade 3 or more (G3+) toxicities happened.

Endpoints:Primary endpoint was incidence of G3+ neutropenia during radiotherapy and one month post-radiotherapy. Complete blood counts were monitored weekly during cCRT and for one month post-treatment or as deemed necessary by the physician.

Following the completion of cCRT and the resolution of acute side effects, patients were followed up at one month post-treatment, then every three months for the first year, and every six months thereafter until disease progression.

Statistical Analysis:The inverse probability of treatment weighting (IPTW) algorithm was applied to balance differences between groups in terms of age, gender, smoking, clinical stage, KPS score, induction therapy received or not, ensuring the reliability of the study results. Statistical analysis was performed using R software (version 4.4.1). All tests were two-sided, with a P-value \<0.05 considered statistically significant.

Detailed Description

Not available

Study Timeline

• Study Start: 2019-09-02
• Primary Completion: 2024-11-07
• Study Completion: 2025-01-30
• Status Verified: 2025-03
• Study First Submitted: 2025-03-28
• Study First Submitted QC: 2025-04-27
• Last Update Submitted: 2025-04-27
• Study First Posted: 2025-05-06
• Last Update Posted: 2025-05-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 213

Inclusion Criteria

1. Diagnosis

   • Histologically confirmed stage II-III non-small cell lung cancer (NSCLC)

2. Treatment Plan

   • Planned to receive concurrent platinum-based chemotherapy with radiotherapy (cCRT)

3. Demographics

   • Age 18-80 years

4. Performance Status

   • Karnofsky Performance Status (KPS) ≥70

5. Organ Function

   • Renal function: Creatinine clearance ≥60 mL/min
   • Hepatic function: Total bilirubin ≤1.5×ULN, AST/ALT ≤2.5×ULN
   • Absolute neutrophil count ≥2.0×10⁹/L
   • Platelets ≥100×10⁹/L
   • Hemoglobin ≥10 g/dL

Exclusion Criteria

1. Active Malignancies

   • Concurrent diagnosis of active malignancies (excluding: non-melanoma skin cancer, carcinoma in situ, or malignancies in complete remission for ≥5 years)

2. Infectious/Immunological Conditions

   • Active systemic infection requiring intravenous antimicrobial therapy
   • Uncontrolled autoimmune diseases (defined as requiring systemic immunosuppressants at doses >10 mg/day prednisone equivalent within 30 days prior to screening)

3. Hypersensitivity Reactions

   • Allergy to PEG-rhG-CSF or other biological products derived from genetically engineered Escherichia coli

4. Neuropsychiatric Impairments

   • Severe psychiatric disorders (e.g., schizophrenia, major depressive disorder with suicidal ideation) requiring hospitalization within 6 months)

5. Prior Radiotherapy

   • History of thoracic radiotherapy involving >30% lung parenchyma or mean heart dose >20 Gy

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Grade 3 or more (G3+) neutropenia	From the first day of radiotherapy to one month after the end of radiotherapy	According to the Radiation Therapy Oncology Group (RTOG) acute radiation injury grading scale

Secondary Outcome Measures

Name	Time	Method
treatment delays	Chemotherapy delay was defined as a delay of ≥7 days	Chemotherapy delay
interruptions	Break in radiotherapy of ≥3 days	Radiotherapy interruption
overall survival (OS)	assessed up to 72 months	the time from the start of cCRT to death from any cause
G3+ thrombocytopenia and anemia	From the first day of radiotherapy to one month after the end of radiotherapy	According to the Radiation Therapy Oncology Group (RTOG) acute radiation injury grading scale
G2+ acute radiation esophagitis (RE) and pneumonitis (RP)	From the first day of radiotherapy to six month after the end of radiotherapy	According to the Radiation Therapy Oncology Group (RTOG) acute radiation injury grading scale
progression-free survival (PFS)	assessed up to 72 months	the time from the start of cCRT to the first event of disease progression

Trial Locations

Locations (1)

National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; 🇨🇳 Beijing, China