Efficacy of pegfilgrastim in preventing febrile neutropenia during DCF chemotherapy for esophageal cancer: A systematic review and meta-analysis

Background: Esophageal cancer remains a leading cause of cancer-related mortality worldwide, with docetaxel, cisplatin, and fluorouracil (DCF) chemotherapy being a standard treatment option for locally advanced disease. However, DCF is associated with a high incidence of febrile neutropenia (FN), a serious complication that can lead to treatment delays, hospitalizations, and increased morbidity. Pegfilgrastim, a long-acting granulocyte colony-stimulating factor (G-CSF), is recommended for FN prevention, but its efficacy in esophageal cancer patients receiving DCF chemotherapy remains unclear. Methods: A systematic literature search of PubMed, Cochrane Library, Scopus, and Web of Science identified eligible studies. Retrospective and prospective studies comparing prophylactic pegfilgrastim with placebo or no G-CSF in patients undergoing DCF therapy were included. Eight reviewers independently screened studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale. The extracted data were then verified by two additional reviewers. A meta-analysis was conducted to calculate pooled effect sizes. Results: Pooled analysis showed that pegfilgrastim significantly reduced FN incidence (OR = 0.283, 95% CI: 0.102–0.782, p = 0.015). FN rates ranged from 3.3% to 30.8% in the pegfilgrastim group versus 26.7% to 60.6% in the control group. Pegfilgrastim was also associated with lower rates of severe neutropenia and shorter hospital stays, with no significant increase in adverse events. Conclusions: In our study, Pegfilgrastim prophylaxis significantly reduces FN risk, severe neutropenia, and hospital stays in esophageal cancer patients receiving DCF chemotherapy, without increasing major complications. These findings support its routine use in this population, though further prospective randomized trials are needed to optimize dosing strategies and confirm long-term benefits. © The Author(s) 2026