Do you routinely utilize G-CSF as primary prophylaxis in patients receiving mFOLFIRINOX or FOLFOXIRI?  

Interesting to see the differences. I can't speak for others in our large GI practice but as we see well over 1000 pancreas cancer patients/year, there is substantial experience with FFX. I personally do not use primary prophylaxis and I/we do not routinely check DPYD. If neutropenia occurs, we add ...

Yes. Routinely. Based on the Yale study of modified FOLFIRINOX (Stein, et al, Br J Ca: 114, 806, 2016), minor reductions in bolus and FU with peg-filgrastim reduced rate of grade 3-4 heme toxicity to 12% with only 4/74 patients having neutropenic fevers. Efficacy appeared equivalent to PRODIGE study...

At my center, we treat about 40 patients/year with modified FOLFIRINOX (no 5-FU bolus, irinotecan at 150mg/m2), and we do not use cycle 1 pegfilgrastim. Febrile neutropenia is very rare, and the addition of pegfilgrastim is also rarely required. We do use routine DPYD genotyping prior to 5-FU chemot...

Agree, regularly use at disconnect prophylactically. Given short half life of the 5FU, feel okay giving on same day of disconnect.