ArticleJCO oncology practice2026
Impact of Primary Prophylactic Colony-Stimulating Factor Delivery Method on Febrile Neutropenia: Secondary Analysis of a Pragmatic Cluster Randomized Clinical Trial.
Article in JCO oncology practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePrimary prophylactic colony-stimulating factor (PP-CSF) is recommended for patients receiving chemotherapy with high risk of febrile neutropenia (FN). The impact of PP-CSF delivery method on FN is unknown. We performed a secondary analysis of SWOG S1415CD (Trial Assessing CSF Prescribing Effectiveness and Risk), a pragmatic, cluster-randomized trial evaluating a guideline-informed standing order system to improve PP-CSF use, to evaluate associations between PP-CSF delivery method and FN.
methodsFemale patients with breast cancer receiving first-line chemotherapy and PP-CSF with a known delivery method (administration in-clinic [IC], home delivery via an on-body device [OBD], or home self-injection [SI]) were included. The primary outcome was FN within 6 months of chemotherapy initiation, defined per the Common Terminology Criteria for Adverse Events.
resultsAmong 1,713 patients, the median age was 55 years (IQR, 46-64). By stage, 566 (33%) were local, 709 (41%) regional, 41 (2%) distant, and 397 (23%) unknown. PP-CSF was delivered IC in 773 (45%), OBD in 862 (50%), and SI in 78 (5%). Most received high-risk FN regimens. Pegfilgrastim use was nearly exclusive in IC and OBD (98% and 99%), versus 29% in SI. FN incidence was low: IC 3.8% (95% CI, 2.5 to 5.3), OBD 5.0% (95% CI, 3.6 to 6.6), and SI 6.4% (95% CI, 2.1 to 14.3;
conclusionWomen with breast cancer receiving chemotherapy and PP-CSF had low rates of FN regardless of PP-CSF delivery method or agent. Delivery decisions may be guided by patient-centered factors including cost, convenience, and access.
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