Efficacy of Early Pegfilgrastim Administration during Preoperative Docetaxel, Cisplatin, and 5-Fluorouracil Therapy in Esophageal Cancer

JMA J. 2026 Jul 15;9(4):958-965. doi: 10.31662/jmaj.2025-0572. Epub 2026 Jun 19.

ABSTRACT

INTRODUCTION: Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy is the standard preoperative chemotherapy for advanced esophageal cancer. Although pegfilgrastim (PEG) is used for prophylaxis, the optimal timing remains unclear. This study aimed to evaluate the safety and efficacy of early PEG administration in DCF therapy.

METHODS: We retrospectively analyzed 50 chemotherapy cycles in 28 patients who underwent preoperative DCF therapy. The patients were divided into two groups based on the timing of PEG administration: day 3 (Early group) and day 7 (Late group). We compared hematologic and nonhematologic toxicities between the groups.

RESULTS: Early PEG administration significantly reduced leukopenia (Early group vs. Late group: 14% vs. 64%) and neutropenia (21% vs. 79%) and was associated with a lower incidence of febrile neutropenia (7% vs. 36%). Early PEG administration also reduced the incidence of grade ≥3 diarrhea and anorexia and improved food oral intake, weight loss, hyponatremia, and anorexia.

CONCLUSIONS: Early administration of PEG on day 3 during preoperative DCF therapy for esophageal cancer significantly reduced severe neutropenia and was associated with improved treatment tolerability compared to standard day 7 administration. These findings suggest that early PEG administration is a safe and effective strategy to enhance the tolerability of intensive chemotherapy.

PMID:42576986 | PMC:PMC13453508 | DOI:10.31662/jmaj.2025-0572