Efficacy of Joungal in preventing febrile neutropenia induced by platinum-based doublet chemotherapy in lung cancer

Abstract

Background: Myelosuppressive chemotherapy often results in febrile neutropenia (FN) in patients with lung cancer, resulting in infection, prolonged hospitalization, higher economic and labor costs, and increased mortality rate. Colony-stimulating factor (CSF) is used to treat FN, but it exhibits limited efficacy and is often underused. We evaluated Joungal, a traditional Chinese medicine, for treatment of neutropenic complications in patients with lung cancer who received chemotherapy. Methods: A total of 795 patients with lung cancer were treated with platinum-based chemotherapy from 2012 to 2017. Of these, 191 received Joungal during chemotherapy. Three hundred eighty-two patients were included in the control group. The primary end point was incidence of FN. The secondary end points were incidence of neutropenia, granulocyte colony-stimulating factor (G-CSF) use, hospitalization duration, and cost. Results: There were no differences in clinicopathological characteristics such as gender, age, smoking status, stage of disease, hemoglobin, or histologic type between two groups. Joungal significantly decreased the incidence of chemotherapy-induced FN (2.1% vs. 9.4%, OR =0.21, P=0.002), grade 2/3/4 neutropenia (29.8 % vs. 55.8%, OR =0.34, P=0.000), and grade 3/4 neutropenia (13.1% vs. 23.8%, OR =0.48, P=0.013) compared with controls. Furthermore, Joungal decreased G-CSF use (0.68 vs. 1.34/patient/cycle, P=0.001), hospitalization duration (2.56 vs. 4.68 day/patient/cycle, P=0.002), and economic burden ($660 vs. $1,580/ patient/cycle, P=0.001). No drug-related toxicity was observed. Conclusions: Joungal safely and effectively decreased the incidence of neutropenia and FN induced by doublet platinum-based chemotherapy in patients with lung cancer, and may have potential as a supportive care agent for patients with lung cancer.