Association of Granulocyte Colony-Stimulating Factor Treatment with Risk of Brain Metastasis in Advanced Stage Breast Cancer

Q: Why is routine GCSF use not recommended for chemotherapy-induced neutropenia prevention or treatment?

The article explains that risks related to certain cancer types, distant organ metastases, and primary tumor growth cannot be excluded, even when used for neutropenia prevention or treatment.

Q: How was the study designed and who were the participants?

It was a retrospective cohort including 121 stage IV breast cancer patients without confirmed brain metastasis at diagnosis who received at least one course of systematic chemotherapy or target therapy between 1 January 2014 and 31 December 2022.

Q: What association did the study find between GCSF treatment and brain metastasis?

Patients receiving GCSF had a significantly higher brain metastasis incidence than nonusers (34.9% vs. 13.8%, p=0.011), with increased adjusted risk (HR 2.538, p=0.025).

Q: Which factors were identified as risk factors for brain metastasis-free survival (BMFS)?

Univariate Cox regression indicated independent risk factors for BMFS including GCSF use, menopause status, hormone treatment, HER2 treatment, cumulative dosage, dosage density, and neutropenia (p<0.05).

Sep 22, 2026

Upload by River Wang

Routine granulocyte colony-stimulating factor (GCSF) use is not recommended for preventing or treating chemotherapy-induced neutropenia because cancer-related risks, distant metastases, and primary tumor growth effects cannot be excluded. This retrospective cohort evaluated whether GCSF use in stage IV breast cancer relates to brain metastasis incidence and brain metastasis-free survival. Cox regression adjusted for confounders. GCSF recipients showed higher brain metastasis incidence (34.9% vs. 13.8%, p=0.011) and increased adjusted risk (HR 2.538, 95% CI 1.127–5.716, p=0.025). Effects varied with neutropenia and dose density.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Background on breast cancer metastasis and brain metastasis

GCSF use in cancer and rationale for the study

Article Association of Granulocyte Colony-Stimulating Factor Treatment with Risk of Brain Metastasis in Advanced Stage Breast Cancer Yun-Sheng Tai 1, John Hang Leung 2, Shyh-Yau Wang 3, Henry W. C. Leung 4,* and Agnes L. F. Chan 5, * Citation: Tai, Y.-S.; Leung, J.H.; Wang, S.-Y.; Leung, H.W.C.; Chan, A.L.F. Association of Granulocyte Colony-Stimulating Factor Treatment with Risk of Brain Metastasis in Advanced Stage Breast Cancer. Int. J. Mol. Sci. 2024, 25, 10756. [https://](https://)[ ](https://)[doi.org/10.3390/ijms251910756](doi.org/10.3390/ijms251910756) Academic Editor: Nam Deuk Kim Received: 31 August 2024 Revised: 2 October 2024 Accepted: 3 October 2024 Published: 6 October 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Breast Surgery, An-Nan Hospital, China Medical University, Tainan 709, Taiwan; [073889@tool.caaumed.org.tw](073889@tool.caaumed.org.tw) 2 Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan; [pc1598jl@gmail.com](pc1598jl@gmail.com) 3 Department of Radiology, An-Nan Hospital, China Medical University, Tainan 709, Taiwan; [023930@tool.caaumed.org.tw](023930@tool.caaumed.org.tw) 4 Department of Radiation Oncology, An-Nan Hospital, China Medical University, Tainan 709, Taiwan 5 Department of Pharmacy, Kaohsiung Show Chwan Memorial Hospital, Kaohsiung 821, Taiwan * Correspondence: [070506@tool.caaumed.org.tw](070506@tool.caaumed.org.tw) (H.W.C.L.); [bigeyefong@gmail.com](bigeyefong@gmail.com) (A.L.F.C.) Abstract: The routine use of granulocyte colony-stimulating factor (GCSF) is not recommended for the prevention or treatment of chemotherapy-induced neutropenia or febrile neutropenia because risks associated with certain types of cancers, distant organ metastases, and primary tumor growth cannot be excluded. We examined the association between GCSF use and the incidence of brain metastasis (BM), as well as BM-free survival (BMFS) . This retrospective cohort study included 121 stage IV breast cancer patients without confirmed BM at the time of diagnosis and who received at least one course of systematic chemotherapy or target therapy at a tertiary teaching hospital between 1 January 2014 and 31 December 2022 . The effect of GCSF use on BM was assessed with other confounding factors in Cox regression analyses. In this retrospective cohort, patients who received GCSF treatment had a significantly higher incidence of BM than those who did not (34.9% vs. 13.8%, p = 0.011) . Univariate Cox regression analysis showed that GCSF use, menopause status, hormone treatment, HER2 treatment, cumulative dosage, dosage density, and neutropenia were independent risk factors for BMFS (p < 0.05) . GCSF users had a higher risk of BM (adjusted HR: 2.538; 95% CI: 1.127–5.716, p = 0.025) than nonusers. BM risk was significantly associated with those with neutropenia (RR: 1.84, 95% CI: 1.21, 2.80) but not with those without neutropenia (RR: 0.59, 95% CI: 0.41–0.84, Interaction p-value < 0.05) . The higher the dose density of GCSF, the higher the risk compared with those who do not use GCSF (p for trend < 0.01) . These preliminary results suggest that GCSF is associated with BM in patients with stage IV breast cancer who did not have BM at initial diagnosis. Further comprehensively designed large-scale observational studies are needed to confirm our preliminary results. Keywords: GCSF; neutropenia; brain metastasis; stage IV breast cancer 1. Introduction Breast cancer is both the second and fourth leading cause of cancer death among women in the United States and Taiwan, respectively. One-third of women

FAQs

Why is routine GCSF use not recommended for chemotherapy-induced neutropenia prevention or treatment?

The article explains that risks related to certain cancer types, distant organ metastases, and primary tumor growth cannot be excluded, even when used for neutropenia prevention or treatment.

How was the study designed and who were the participants?

It was a retrospective cohort including 121 stage IV breast cancer patients without confirmed brain metastasis at diagnosis who received at least one course of systematic chemotherapy or target therapy between 1 January 2014 and 31 December 2022.

What association did the study find between GCSF treatment and brain metastasis?

Patients receiving GCSF had a significantly higher brain metastasis incidence than nonusers (34.9% vs. 13.8%, p=0.011), with increased adjusted risk (HR 2.538, p=0.025).

Which factors were identified as risk factors for brain metastasis-free survival (BMFS)?

Univariate Cox regression indicated independent risk factors for BMFS including GCSF use, menopause status, hormone treatment, HER2 treatment, cumulative dosage, dosage density, and neutropenia (p<0.05).

Sep 22, 2026

Upload by River Wang