Growth Factor Administration in Pancreatic Cancer Treatment

It is common practice for clinicians to administer granulocyte colony-stimulating factor (G-CSF) — a growth factor used to replenish white blood cell counts — during chemotherapy, but what are its effects on overall survival in patients with pancreatic cancer?  

Recently published in the Journal of the National Comprehensive Cancer Center Network, UPMC Hillman Cancer Center researchers and colleagues found that the administration of G-CSF during neoadjuvant therapy was associated with worse oncologic outcomes and overall survival in patients with resected pancreatic cancer.

Although there has been progress in pancreatic ductal adenocarcinoma (PDAC) treatment, it is still a highly aggressive disease that needs more effective and tolerable treatments. Authors suggest that optimizing current treatment protocols could lead to incremental but important improvements in outcomes. One of these potential changes includes how clinicians use growth factors like G-CSF.

“Neoadjuvant chemotherapy has been increasingly used in patients with PDAC, but little is known about the long-term impact of growth factor support,” says senior author Amer Zureikat, MD, Director of Surgical Oncology at UPMC Hillman Cancer Center.

To determine how G-CSF administration affected outcomes, authors conducted a retrospective cohort study of 351 patients, of which 138 patients received the growth factor support. Despite having a similar diagnostic tumor size, diagnostic CA 19-9 biomarker levels, and duration of total chemotherapy cycles as non-recipients, patients receiving G-CSF demonstrated:

  • Increased post-NAT inflammatory mediators, including a higher neutrophil to lymphocyte ratio and circulating neutrophil extracellular traps — that suppress antitumor immunity and promote tumor growth.
  • Worse pathologic outcomes, including higher incidence of margin positive resection and lymphovascular invasion.
  • Decreased overall survival, independent of treatment type or patient characteristics.

“The observed differences were striking,” says Dr. Zureikat. “This suggests a potentially more aggressive tumor phenotype or systemic immune dysfunction associated with or exacerbated by G-CSF administration.”

Due to these results, authors determined that administration of G-CSF should be carefully considered with alternate approaches to manage chemotherapy induced myelosuppression and that further investigation is warranted.


Murthy P, Zenati MS, AlMasri SS, et al. Impact of Recombinant Granulocyte Colony-Stimulating Factor During Neoadjuvant Therapy on Outcomes of Resected Pancreatic Cancer. J Natl Compr Canc Netw. 2024;22(1D):1-10.e2. doi:10.6004/jnccn.2023.7070

Written by: Annaliese Daniels
Edited by: Amer Zureikat

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