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Scotté F, Artru P, Saghatchian M, Chouaid C. Leveraging G-CSF prescribing in the outpatient setting: considerations beyond clinical factors-a questionnaire study. Support Care Cancer 2024; 32:347. [PMID: 38743147 DOI: 10.1007/s00520-024-08524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This study aims to delineate G-CSF treatment practices, assess decision criteria, and measure their implementation in ambulatory settings for patients with breast (BC), lung (LC), or gastrointestinal cancers (GIC), beyond standard recommendations. METHODS In this non-interventional, cross-sectional, multicenter study, clinical cases were presented using conversational interfaces (chatbots), simulating a conversation with one or more virtual interlocutors through voice or text exchange. The clinical simulations were configured by four parameters: types of cancer, risk of FN related to chemotherapy and comorbidities, access to care, and therapy setting (adjuvant/neoadjuvant/metastatic). RESULTS The questionnaire was completed by 102 physicians. Most practitioners (84.5%) reported prescribing G-CSF, regardless of tumor type. G-CSF was prescribed more frequently for adjuvant/neoadjuvant therapy than for metastatic cases. The type of chemotherapy was cited as the first reason for prescribing G-CSF, with access to care being the second. Regarding the type of chemotherapy, physicians do not consider this factor alone, but combined with comorbidities and age (56.7% of cases). Pegfilgrastim long-acting was prescribed in most cases of BC and LC (70.1% and 86%, respectively), while filgrastim short-acting was named in the majority of cases of GIC (61.7%); 76.3% of physicians prescribed G-CSF as primary prophylaxis. CONCLUSIONS Our findings suggest that recommended practices are broadly followed. In the majority of cases, G-CSF is prescribed as primary prophylaxis. In addition, physicians seem more inclined to prescribe G-CSF to adjuvant/neoadjuvant patients rather than metastatic patients. Finally, the type of chemotherapy tends to be a more significant determining factor than the patient's background.
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Affiliation(s)
- Florian Scotté
- Interdisciplinary Patient Pathway Department, Gustave Roussy, Villejuif, France.
| | - Pascal Artru
- Gastrointestinal Oncology Department, Hôpital Jean Mermoz, Lyon, France
| | - Mahasti Saghatchian
- Oncology Department, American Hospital of Paris, Neuilly-Sur-Seine, France
- Faculty of Medicine, Université Paris Cité, Paris, France
| | - Christos Chouaid
- Pneumology Department, CHI Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, Créteil, France
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Zhu X, Zhang W, Zhang Y, Wang Y, Hu H, Li J, Zhou Y, Han T, Huang D. Pegfilgrastim on febrile neutropenia in pediatric and adolescent cancer patients: a systematic review and meta-analysis. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2023; 28:2172292. [PMID: 36719297 DOI: 10.1080/16078454.2023.2172292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES There is no meta-analysis about the effects of pegfilgrastim on the occurrence of febrile neutropenia (FN) in pediatric/adolescent cancer patients. The study explored the efficacy of prophylactic pegfilgrastim in preventing FN in children/adolescents with cancer. METHODS PubMed, Embase, and the Cochrane Library were searched for studies published before April 7, 2020. The primary outcome was the rate of FN. Effect size (ES) and odds ratio (OR) with 95% confidence intervals (CIs) were used to evaluate the outcome. The ES represented the rate of FN, and the STATA 'metaprop' command was used to synthesize the rate. RESULTS Eight studies were included, comprising 167 patients and 550 courses of treatment. There was no difference between pegfilgrastim and filgrastim for the rate of FN in children receiving chemotherapy (OR = 0.68, 95% CI: 0.20-2.23, P = 0.520). In patients receiving pegfilgrastim, the rate of FN was 25.6% (95% CI: 14.9%-36.3%), the rate of grade 4 FN was 38.3% (95% CI: 19.2%-59.5%), the rate of severe neutropenia (SN) was 40.5% (95% CI: 35.1%-46.1%), and the rate of treatment delays due to FN was 4.8% (95% CI: 0.8%-11.3%). DISCUSSION The number of studies that could be included was small; therefore, a specific type of cancer or a specific treatment could be studied. Heterogeneity was high. CONCLUSION There was no difference between pegfilgrastim and filgrastim for the rate of FN. The use of pegfilgrastim was still associated with rates of FN, grade 4 FN, severe neutropenia, and treatment delays due to FN in pediatric cancer patients.
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Affiliation(s)
- Xia Zhu
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Weiling Zhang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Yizhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Huimin Hu
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Jing Li
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Yan Zhou
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Tao Han
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
| | - Dongsheng Huang
- Department of Pediatrics, Beijing Tongren Hospital Capital Medical University, Beijing, People's Republic of China
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You Z, Zhang H, Huang Y, Zhao L, Tu H, Zhang Y, Lin X, Liang W. Assessing the Optimal Regimen: A Systematic Review and Network Meta-Analysis of the Efficacy and Safety of Long-Acting Granulocyte Colony-Stimulating Factors in Patients with Breast Cancer. Cancers (Basel) 2023; 15:3675. [PMID: 37509336 PMCID: PMC10378237 DOI: 10.3390/cancers15143675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Patients with breast cancer undergoing chemotherapy are susceptible to prolonged and severe neutropenia. Multiple biosimilars of long-acting granulocyte colony-stimulating factors (LA-G-CSFs) have been newly developed to prevent this disease. Nonetheless, which LA-G-CSF regimen has the optimal balance of efficacy and safety remains controversial. Moreover, there is a lack of evidence supporting clinical decisions on LA-G-CSF dose escalation in poor conditions. PubMed, Embase, Cochrane Library, Web of Science, and several Chinese databases were searched (December 2022) to collect randomized controlled trials (RCTs) about LA-G-CSFs preventing chemotherapy-induced neutropenia in breast cancer patients. No restrictions were imposed on language. A Bayesian network meta-analysis was performed. We assessed the incidence of severe neutropenia (SN) and febrile neutropenia (FN), the duration of SN (DSN), and the absolute neutrophil account recovery time (ANCrt) for efficacy, while the incidence of severe adverse events (SAE) was assessed for safety. The study was registered in PROSPERO (CRD42022361606). A total of 33 RCTs were included. Our network meta-analysis demonstrated that lipegfilgrastim 6 mg and eflapegrastim 13.2 mg outperformed other LA-G-CSFs with high efficacy rates and few safety concerns (SUCRA of lipegfilgrastim 6 mg: ANC rt 95.2%, FN 97.4%; eflapegrastim 13.2 mg: FN 87%, SN 89.3%). Additionally, 3.6 mg, 4.5 mg, 6 mg, and 13.2 mg dosages all performed significantly better than 1.8 mg in reducing the duration of SN (3.6 mg: DSN, SMD -0.68 [-1.13, -0.22; moderate]; 4.5 mg: -0.87 [-1.57, -0.17; low]; 6 mg: -0.89 [-1.49, -0.29; moderate]; 13.2 mg: -1.02 [1.63, -0.41; high]). Increasing the dosage from the guideline-recommended 6 mg to 13.2 mg can reduce both the duration and incidence of SN (SMD -0.13 [-0.24 to -0.03], RR 0.65 [0.43 to 0.96], respectively), with no significant difference in SAE. For patients with breast cancer, lipegfilgrastim 6 mg and eflapegrastim 13.2 mg might be the most effective regimen among LA-G-CSFs. Higher doses of LA-G-CSF may enhance efficacy without causing additional SAEs.
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Affiliation(s)
- Zhixuan You
- Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou 510182, China
| | - Haotian Zhang
- Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou 510182, China
| | - Yining Huang
- Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou 510182, China
| | - Lei Zhao
- Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou 510182, China
| | - Hengjia Tu
- Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou 510182, China
| | - Yuzhuo Zhang
- Department of Clinical Medicine, Nanshan School, Guangzhou Medical University, Guangzhou 510182, China
| | - Xinqing Lin
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Wenhua Liang
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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De Oliveira Brandao C, Lewis S, Sandschafer D, Crawford J. Two decades of pegfilgrastim: what have we learned? Where do we go from here? Curr Med Res Opin 2023; 39:707-718. [PMID: 36976784 DOI: 10.1080/03007995.2023.2196197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Chemotherapy-induced febrile neutropenia (FN) is a medical emergency that may occur in patients with malignancies receiving myelosuppressive chemotherapy. FN requires early therapeutic intervention since it is associated with increased hospitalizations and high mortality risk of 5%-20%. FN-related hospitalizations are higher in patients with myeloid malignancies than in those with solid tumors due to the myelotoxicity of chemotherapy regimens and the compromised bone marrow function. FN increases the burden of cancer by causing chemotherapy dose reductions and delays. The administration of the first granulocyte colony-stimulating factor (G-CSF), filgrastim, reduced the incidence and duration of FN in patients undergoing chemotherapy. Filgrastim later evolved into pegfilgrastim, which has a longer half-life than filgrastim and was associated with a lower rate of severe neutropenia, chemotherapy dose reduction, and treatment delay. Nine million patients have received pegfilgrastim since its approval in early 2002. The pegfilgrastim on-body injector (OBI) is an innovative device facilitating the time-released auto-injection of pegfilgrastim approximately 27 hours after chemotherapy, as clinically recommended for the prevention of FN, thus eliminating the need for a next-day hospital visit. Since its introduction in 2015, one million patients with cancer have received pegfilgrastim using the OBI. Subsequently, the device has been approved in the United States (US), European Union, Latin America, and Japan, with studies and a postmarketing commitment demonstrating device reliability. A recent prospective observational study conducted in the US demonstrated that the OBI substantially improved the adherence to and compliance with clinically recommended pegfilgrastim therapy; patients receiving pegfilgrastim via the OBI experienced a lower incidence of FN than those receiving alternatives for FN prophylaxis. This review discusses the evolution of G-CSFs leading to the development of the OBI, current recommendations for G-CSF prophylaxis in the clinic, continued evidence supporting next-day pegfilgrastim administration, and improvements in patient care made possible with the OBI.
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Affiliation(s)
| | - Sandra Lewis
- Global Research & Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Jeffrey Crawford
- Medical Oncology, Division of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Real-World Use of Granulocyte-Colony Stimulating Factor in Patients with Breast Cancer from Alberta, Canada. Cancers (Basel) 2022; 14:cancers14246197. [PMID: 36551681 PMCID: PMC9777054 DOI: 10.3390/cancers14246197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There are limited published data in the Canadian healthcare system on the use of granulocyte colony-stimulating factor (G-CSF) among patients with breast cancer. This study characterized real-world G-CSF use during the period surrounding the introduction of filgrastim biosimilar. METHODS Electronic medical records were reviewed retrospectively for patients with breast cancer who received moderately or highly myelosuppressive (neo)adjuvant chemotherapy from 2008 to 2019 in Alberta, Canada. Trends in G-CSF usage were plotted to elucidate temporal variations and multivariable regression models were constructed to identify clinical factors associated with G-CSF use. RESULTS We included 6662 patients in our analyses. G-CSF was used in 57.1% of patients during their treatment trajectory. Among the 3801 patients who were treated with G-CSF, the majority received pegfilgrastim only (91.5%; n = 3477) versus filgrastim only (5.7%; n = 217). G-CSF use increased linearly more than two-fold over the 11-year study period. Predictors of G-CSF use included younger age, south zone of residence, higher neighborhood education, inferior disease stage, highly neutropenic risk chemotherapy, and more recent chemotherapy initiation. CONCLUSIONS Despite increasing G-CSF usage over time, an appreciable proportion of patients for whom G-CSF prophylaxis is recommended did not receive it. G-CSF use could be further optimized to align with supportive care clinical guidelines and reduce the impact of neutropenia and its associated complications.
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Kaplan S, Bogojevic DI, Rainville C, Gross N. A multinational, drug utilization study of lipegfilgrastim use in real-world setting in Europe. Support Care Cancer 2022; 30:9191-9201. [PMID: 36044089 DOI: 10.1007/s00520-022-07341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Lipegfilgrastim (Lonquex, Teva Pharma B.V.) is approved for reduction in neutropenia duration and febrile neutropenia incidence. In the framework of lipegfilgrastim regulatory approval in the EU, the Health Authorities requested a drug utilization study. This study was conducted to characterize prescribing patterns of lipegfilgrastim and quantify the extent of on- and off-label use of lipegfilgrastim in real-world setting in Europe. METHODS Information on lipegfilgrastim use between January 2014 and March 2020 was abstracted from medical records in hospital and outpatient clinical settings. Indication for lipegfilgrastim was classified either as on-label or off-label use according to pre-determined criteria. The primary endpoint was the extent of lipegfilgrastim off-label use based on the most recent lipegfilgrastim cycle. RESULTS Records of 481 patients were obtained from five European countries. Lipegfilgrastim was most commonly prescribed for prevention of neutropenia by oncologists and hematologists. Patients who were administered lipegfilgrastim were primarily ≥ 55 years old (65.1%) and female (65.7%). The most frequent underlying diagnosis was breast cancer (38.3%). For the most recent lipegfilgrastim cycle, on-label use was recorded in 452/459 patients with no missing data (98.5%), while off-label use was recorded in 7/459 patients (1.5%). The majority of off-label use was attributed to use with non-cytotoxic chemotherapy (57.1%). Off-label use of lipegfilgrastim across all treatment cycles with no missing data was 11/1547 cycles (0.7%). CONCLUSION Using real-world data, these findings confirm the low rate of lipegfilgrastim off-label use as reported in a preceding feasibility study, indicating very high adherence to the approved indication.
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Affiliation(s)
- Sigal Kaplan
- Teva Pharmaceutical Industries Ltd, 12 Hatrufa St, 4250483, Netanya, Israel.
| | - Dana Ilic Bogojevic
- Teva Pharmaceutical Industries Ltd, 400 Interpace Pkwy, Parsippany, NJ, 07054, USA
| | - Carolyn Rainville
- Teva Pharmaceutical Industries Ltd, 41 Moores Road, Malvern, PA, 19355, USA
| | - Nicholas Gross
- Teva Pharmaceutical Industries Ltd, 145 Brandywine Pkwy, West Chester, PA, 19380, USA
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Jiménez Nieves Y, Ortiz-Ortiz KJ, Ríos Motta RE, Castañeda-Avila MA, Tortolero-Luna G. Granulocyte colony stimulating factor use and adherence to clinical practice guidelines among women with breast cancer living in Puerto Rico: a population-based study. BMC Health Serv Res 2022; 22:935. [PMID: 35858914 PMCID: PMC9299407 DOI: 10.1186/s12913-022-08325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Febrile Neutropenia (FN) is a common and serious condition related to cancer chemotherapy. Human recombinant Granulocyte-Colony Stimulating Factor (G-CSF) prevents and attenuates the severity and duration of FN. We evaluated the use and predictors of G-CSF adherence among women with breast cancer with a high risk of FN in Puerto Rico. Methods This retrospective cohort study used the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. Women with invasive breast cancer diagnosed during 2009-2015 who received selected chemotherapy regimens (n = 816) were included. The risk of FN was categorized as high and low risk based on the chemotherapy regimens according to the National Comprehensive Cancer Network guidelines and literature. Adherence was defined as the use or no use of G-CSF at the start of the first chemotherapy cycle among women with breast cancer based on the risk of developing FN. We used a multivariate logistic model to identify factors associated with G-CSF use in women classified at high risk for FN. Results Adherence to G-CSF clinical practice guidelines was low (38.2%) among women with a high risk of FN. Women at high risk of FN with Medicaid (aOR: 0.14; CI 95%: 0.08, 0.24) and Medicare/Medicaid (aOR: 0.33; CI 95%: 0.15, 0.73) were less likely to receive G-CSF than women with private health insurance. Women with regional stage (aOR: 1.82; CI 95%: 1.15, 2.88) were more likely to receive G-CSF than women with localized cancers. Conclusions Adherence to clinical practice guidelines was poor among women with a high risk of FN. Furthermore, disparities in the adherence to G-CSF use in terms of health insurance, health region, and cancer stage granted the opportunity to implement strategies to follow the recommended guidelines for using G-CSF as part of cancer treatment.
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Affiliation(s)
- Yarixabeth Jiménez Nieves
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. .,Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico. .,Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth E Ríos Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Maira A Castañeda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico.,Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
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Blayney DW, Schwartzberg L. Chemotherapy-Induced Neutropenia and Emerging Agents for Prevention and Treatment: A Review. Cancer Treat Rev 2022; 109:102427. [DOI: 10.1016/j.ctrv.2022.102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/02/2022]
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Agegnew Wondm S, Dagnew EM, Tadesse Abegaz S, Kiflu M, Kebede B. Burden, risk factors, and management of neutropenic fever among solid cancer patients in Ethiopia. SAGE Open Med 2022; 10:20503121221098236. [PMID: 35646361 PMCID: PMC9130822 DOI: 10.1177/20503121221098236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives: Although neutropenic fever is one of the most well-known oncologic
emergencies and the common causes of death, a few studies have been
conducted in resource-limited countries, particularly in Ethiopia. This
study aimed to assess the burden, risk factors, and management of
neutropenic fever among solid cancer patients in Ethiopia. Methods: A hospital-based retrospective follow-up study was conducted from January
2017 to February 2021. Data were collected from patient’s medical charts
using a structured data abstraction format and analyzed using STATA version
14.2. Logistic regression analyses were used to identify independent
predictors of neutropenic fever, and a p-value of < 0.05
was considered statistically significant. Results: A total of 416 patients were included, with a mean age of 51 ± 14 years. The
cumulative incidence of neutropenic fever was 13%. Advanced age, low
baseline white blood cell, prolonged duration of neutropenia, and presence
of two or more comorbidities were factors significantly associated with
neutropenic fever (p < 0.05). Among patients who need
primary prophylaxis, 68% of patients did not get appropriate primary
prophylaxis, and 30%, 71%, and 93% of prescribed anti-bacterial,
anti-fungal, and anti-viral agents were inappropriate according to
Infectious Disease Society of America Guideline, respectively. Conclusion: Neutropenic fever was common among solid cancer patients and it is
multifactorial. The rate of guideline adherence during prophylaxis and
treatment of neutropenic fever was poor. Health care professionals should be
aware of these risk factors, and greater effort is needed to reduce the risk
of neutropenic fever.
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Affiliation(s)
- Samuel Agegnew Wondm
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ephrem Mebratu Dagnew
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Sumeya Tadesse Abegaz
- Clinical Pharmacy Department, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mekdes Kiflu
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Kebede
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Alsuhebany N, Brown J, Echave J, McBride A. Evaluation of Emergency Department Visits by Oncology Patients: A Running Comparison to Admissions and ED Visits Under the CMS OP-35 Ruling. J Adv Pract Oncol 2022; 13:367-378. [PMID: 35755896 PMCID: PMC9214961 DOI: 10.6004/jadpro.2022.13.4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Cancer is the second leading cause of death in the United States. The incidence of emergency department (ED) visits by oncology patients has grown over the past years. Some ED visits are medically unnecessary and could be prevented with improved prevention measures. Objectives To evaluate the incidence and causes of ED visits by cancer patients and evaluate outcomes and disposition of ED visits. Methods This single-center, retrospective chart review was conducted in a tertiary medical hospital. We collected data using an electronic medical record and included oncology patients with active cancer who had ED visits from January 1, 2018, to December 31, 2018. Key data collection included baseline demographics; type of malignancy; main chief complaint; clinic visit history; current and past ED visits; treatment and supportive care data; and disposition status if admitted. Pregnant patients, patients without active cancer, and patients who received outpatient care at clinics other than the University of Arizona Cancer Center were excluded. Results This chart review study screened 1,659 encounters and included 205 encounters. Approximately 70% of the encounters were solid tumor patients and 30% were hematologic malignancies. Nearly 50% of the patients with hematologic malignancies had preventable ED visits while 32.8% of solid tumor patients had preventable ED visits. The most common preventable ED visit reasons in both groups were pain, fever, nausea, vomiting, and dehydration. Almost 50% of the patients in both groups were hospitalized with a median length of stay of 3 days. The majority of admitted patients were discharged home in both the solid tumor (82.3%) and hematologic malignancy (83.8%) groups. Conclusion This study showed that the rate of preventable visits was numerically higher in the hematologic cancer group compared with the solid tumor group. These findings highlight the potential need for implementing prevention measures in the future.
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Affiliation(s)
- Nada Alsuhebany
- From College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;,King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia;,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jamie Brown
- Phoenix Children's Hospital, Phoenix, Arizona
| | | | - Ali McBride
- The University of Arizona Cancer Center, Tucson, Arizona
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Patterns of primary prophylactic granulocyte colony-stimulating factor use in older Medicare patients with cancer receiving myelosuppressive chemotherapy. Support Care Cancer 2022; 30:6327-6338. [PMID: 35482126 DOI: 10.1007/s00520-022-06967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Guidelines recommend primary prophylactic (PP) granulocyte colony stimulating factor (G-CSF) for prevention of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy with high risk (HR: > 20%), or intermediate risk (IR:10-20%) of FN and ≥ 1 patient risk factor (e.g., age ≥ 65y). The current retrospective cohort study describes patterns of PP-G-CSF in older Medicare patients undergoing myelosuppressive chemotherapy with HR/IR of FN. METHODS Patients aged ≥ 66y initiating chemotherapy regimens with HR/IR of FN to treat breast, colorectal, lung, or ovarian cancer, or Non-Hodgkin's Lymphoma were selected using Medicare 20% sample (2013-2015) and 100% cancer patient (2014-2017) data. PP-G-CSF use was identified in the first cycle. Timing of pegfilgrastim pre-filled syringe (PFS) administration, proportion of patients completing all cycles (adherence) with pegfilgrastim PFS or on-body injector (OBI), and duration of short-acting G-CSF (sG-CSF) was described across all cycles. RESULTS Of 64,893 patients receiving HR/IR for FN, 71% received HR and 29% IR regimens. Overall, PP-G-CSF use in the first cycle was 53% (HR: 74%; IR: 44%) and varied across cancers. Adherence with pegfilgrastim was slightly higher among OBI initiators (78%) than PFS (74%). Number of PP-sG-CSF administrations (mean [SD]) per cycle was 5.1 (SD: 2.7) overall, 5.4 (2.6) for HR, and 4.9 (2.7) for IR. CONCLUSION Despite cancer treatment guidelines recommending PP-G-CSF use to reduce risk of FN associated with HR and IR (with ≥ 1 patient risk-factor) regimens, PP-G-CSF remains underutilized in older patients, across cancer types and regimens. Opportunities exist for improvement in use of PP-G-CSF.
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Wong G, Wang K, Pasetka M, Zhang L, Lou J, Majeed H, Flores J, Lam E, DeAngelis C. The Real-World Experience of the Biosimilar (Grastofil®) to the Reference Biologic (Neupogen®) in Breast Cancer and Lymphoma: A Canadian Single-Centre Retrospective Study. Curr Oncol 2022; 29:1349-1369. [PMID: 35323315 PMCID: PMC8947031 DOI: 10.3390/curroncol29030115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Febrile neutropenia (FN) is a common side effect of cytotoxic chemotherapy that may result in poor treatment outcomes. The short acting granulocyte colony stimulating factors (G-CSF) act to stimulate granulocytes to increase production of white blood cells. The filgrastim biosimilar is useful, as it may provide a cheaper and equally effective treatment to FN. This study explored the usage of the filgrastim biosimilar (Grastofil®) and the reference biologic (Neupogen®) in breast cancer and lymphoma patients. A retrospective chart review of patients receiving Grastofil® from January 2017 to June 2019 or Neupogen® for primary prophylaxis of FN from January 2013 to December 2017 was conducted. The endpoints included the incidence of FN and the occurrence of dose reduction (DR) and dose delay (DD). One hundred and fifty-three Grastofil® patients were matched to 153 Neupogen® patients. This cohort was further split into breast cancer (n = 275) and non-Hodgkin’s lymphoma (n = 31) cohorts. After adjusting for chemotherapy cycles, the biosimilar filgrastim was non-inferior to the reference biologic based on FN incidence in addition to related outcomes including DR and DD.
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Affiliation(s)
- Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
- Correspondence:
| | - Katie Wang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Mark Pasetka
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Liying Zhang
- Macrostat Inc., Toronto, ON L4B 4P4, Canada; (L.Z.); (J.L.)
| | - Julia Lou
- Macrostat Inc., Toronto, ON L4B 4P4, Canada; (L.Z.); (J.L.)
| | - Habeeb Majeed
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Jerome Flores
- Department of Pharmacy, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada; (K.W.); (M.P.); (H.M.); (E.L.); (C.D.)
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13
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Venäläinen MS, Heervä E, Hirvonen O, Saraei S, Suomi T, Mikkola T, Bärlund M, Jyrkkiö S, Laitinen T, Elo LL. Improved risk prediction of chemotherapy-induced neutropenia-model development and validation with real-world data. Cancer Med 2021; 11:654-663. [PMID: 34859963 PMCID: PMC8817096 DOI: 10.1002/cam4.4465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The existing risk prediction models for chemotherapy-induced febrile neutropenia (FN) do not necessarily apply to real-life patients in different healthcare systems and the external validation of these models are often lacking. Our study evaluates whether a machine learning-based risk prediction model could outperform the previously introduced models, especially when validated against real-world patient data from another institution not used for model training. METHODS Using Turku University Hospital electronic medical records, we identified all patients who received chemotherapy for non-hematological cancer between the years 2010 and 2017 (N = 5879). An experimental surrogate endpoint was first-cycle neutropenic infection (NI), defined as grade IV neutropenia with serum C-reactive protein >10 mg/l. For predicting the risk of NI, a penalized regression model (Lasso) was developed. The model was externally validated in an independent dataset (N = 4594) from Tampere University Hospital. RESULTS Lasso model accurately predicted NI risk with good accuracy (AUROC 0.84). In the validation cohort, the Lasso model outperformed two previously introduced, widely approved models, with AUROC 0.75. The variables selected by Lasso included granulocyte colony-stimulating factor (G-CSF) use, cancer type, pre-treatment neutrophil and thrombocyte count, intravenous treatment regimen, and the planned dose intensity. The same model predicted also FN, with AUROC 0.77, supporting the validity of NI as an endpoint. CONCLUSIONS Our study demonstrates that real-world NI risk prediction can be improved with machine learning and that every difference in patient or treatment characteristics can have a significant impact on model performance. Here we outline a novel, externally validated approach which may hold potential to facilitate more targeted use of G-CSFs in the future.
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Affiliation(s)
- Mikko S Venäläinen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Eetu Heervä
- Department of Oncology, Turku University Hospital and FICAN West, Turku, Finland.,University of Turku, Turku, Finland
| | - Outi Hirvonen
- Department of Oncology, Turku University Hospital and FICAN West, Turku, Finland.,Department of Clinical Oncology, University of Turku, Turku, Finland.,Palliative Center, Turku University Hospital, Turku, Finland
| | - Sohrab Saraei
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Tomi Suomi
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Toni Mikkola
- Tays Research Services, Clinical Informatics Team, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Maarit Bärlund
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sirkku Jyrkkiö
- Department of Oncology, Turku University Hospital and FICAN West, Turku, Finland
| | - Tarja Laitinen
- Department of Pulmonary Medicine, University of Turku and Turku University Hospital, Turku, Finland.,Administration Center, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Laura L Elo
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland.,Institute of Biomedicine, University of Turku, Turku, Finland
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14
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Poon DMC, Chan K, Chan TW, Ng B, Siu S, Ng J, Johnson D, Lee KC. Prevention of docetaxel-associated febrile neutropenia with primary granulocyte colony-stimulating factor in Chinese metastatic hormone-sensitive and castration-resistant prostate cancer patients. Asia Pac J Clin Oncol 2021; 17 Suppl 3:39-47. [PMID: 33860642 DOI: 10.1111/ajco.13578] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Asian prostate cancer (PC) patients are particularly susceptible to docetaxel-related febrile neutropenia (FN). We evaluated primary granulocyte colony-stimulating factor (GCSF) for preventing FN in Chinese patients with metastatic hormone-sensitive PC (mHSPC) and castration-resistant PC (mCRPC). PATIENTS AND METHODS Data from two cohorts of 377 Chinese patients with mHSPC (100; 26.5%) and mCRPC (277; 73.5%) treated with docetaxel at six public oncology centres were analysed with multivariate regression. Primary GCSF prophylaxis was defined as administration within 5 days of starting docetaxel. The primary outcome was FN within 21 days of the first docetaxel cycle (1st FN). RESULTS Primary GCSF was given to 71 (18.8%) patients. FN occurred in 61 patients (16.2%) including 37 (9.8%) during the first cycle. Among patients who developed 1st cycle FN (n = 37) or not (n = 340), 2 and 69 received primary GCSF (5.4 vs. 20.3%, P = .03). Primary GCSF was associated with an overall reduced risk of 1st cycle FN (odds ratio [OR] = 0.22; 95% confidence interval [CI]: 0.05-0.96, P = .04), and similar trends were observed in the mHSPC (OR = 0.36, P = .35) and mCRPC (OR = 0.16, P = .08) subgroups. Poor Eastern Cooperative Oncology Group performance status (>1) was associated with an increased risk of 1st FN (OR = 3.90; 95% CI: 1.66-9.13, P = .002). CONCLUSIONS To alleviate the risk of docetaxel-related FN, primary GCSF prophylaxis is suggested for Asian mCRPC and mHSPC patients, particularly those with poor performance status.
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Affiliation(s)
- Darren M C Poon
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Sir Y.K. Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong.,Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
| | - Kuen Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Tim-Wai Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Bryan Ng
- Department of Oncology, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Steven Siu
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong Island, Hong Kong
| | - Joyce Ng
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Sir Y.K. Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - David Johnson
- Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Sir Y.K. Pao Centre for Cancer, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Ka Chai Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories, Hong Kong
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15
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Orji CC, Brown CM, Hoverman JR, Richards KM, Garey J, He B. Impact of a G-CSF Policy to Reduce Low-Value Care on Guideline Adherence and Mortality. JCO Oncol Pract 2021; 17:e1830-e1836. [PMID: 33852326 DOI: 10.1200/op.20.01045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Practice guidelines recommend the prophylactic use of granulocyte colony-stimulating factors (G-CSFs) in patients with high risk of febrile neutropenia, but evidence suggests that G-CSFs are frequently overused. The objectives of this study were (1) to determine the prevalence and prescribing patterns of G-CSF and (2) to evaluate the impact of a program initiative on G-CSF prescribing patterns, adherence to guidelines, and mortality. METHODS In this retrospective cohort study, data were used from the electronic health records of patients with metastatic colorectal cancer who received care at a multicenter oncology practice network during two time periods: July 01, 2013, to December 31, 2014, and July 01, 2017, to December 31, 2017. Beginning 2016, a site-wide program initiative that involved educational materials, appropriate nonuse recommendations, and prior authorization was introduced in the oncology practice network with an aim of reducing G-CSF overutilization. Descriptive statistics, t tests, and chi-squared tests were employed to analyze program impact. RESULTS There were 3,426 chemotherapy regimens corresponding to 2,968 patients. There were a total of 387 (11.3%) G-CSF-treated patients and 3,095 G-CSF administrations during the study period. G-CSF use was significantly lower in the postperiod, compared with the preperiod (P < .0001). Adherence to guidelines was significantly higher in the postperiod, compared with the preperiod (P < .0001). Mortality rates did not significantly differ between the two time periods. CONCLUSION This study demonstrates that policy initiatives have the potential to positively affect G-CSF prescription patterns and promote guideline adherence. These findings could help prescribers adopt a cost-effective approach in patients with metastatic colorectal cancer, leading to enhanced clinical practice and value-based care.
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Affiliation(s)
- Chinelo C Orji
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | - Carolyn M Brown
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | | | - Kristin M Richards
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | - Jody Garey
- McKesson Specialty Health, The Woodlands, TX
| | - Bo He
- McKesson Specialty Health, The Woodlands, TX
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16
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Salako O, Okunade KS, Adeniji AA, Fagbenro GT, Afolaranmi OJ. Chemotherapy induced neutropenia and febrile neutropenia among breast cancer patients in a tertiary hospital in Nigeria. Ecancermedicalscience 2021; 15:1188. [PMID: 33777181 PMCID: PMC7987487 DOI: 10.3332/ecancer.2021.1188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study assessed the incidence of chemotherapy-induced neutropenia and febrile neutropenia (FN) while identifying their associated factors. Methods A prospective cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a 2-year period. Socio-demographic, clinical and haematological data were obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected 2 weeks after each course of chemotherapy. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 was used to assess FN, neutropenia and their severity. Results The incidence of neutropenia and FN among the patients was 31.9% and 5.3%, respectively. Throughout all courses of chemotherapy (n = 502), there were 57 (11.4%) neutropenic episodes with 6.6% mild, 3.4% moderate and 1.4% severe neutropenia. The incidence of neutropenia decreased with increasing chemotherapy courses, with a rate of 14.2% and 4.9% after the first and last course, respectively. Factors associated with the risk of developing neutropenia include increasing age (p = 0.014), Eastern Cooperative Oncology Group performance score ≥ 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). Conclusion One in three breast cancer patients in this study developed neutropenia while on chemotherapy but no independent risk factors were identified for FN among these patients. This study has, therefore, provided the preliminary data necessary for further independent validation of the identified risk factors for FN in a more robust and well-designed study within our clinical practice setting in Nigeria.
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Affiliation(s)
- Omolola Salako
- Radiodiagnosis, Radiation Biology and Radiotherapy Department, College of Medicine, University of Lagos, Lagos 100254, Nigeria
| | | | - Adeoluwa Akeem Adeniji
- Oncology and Radiotherapy Department, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Gabriel Timilehin Fagbenro
- Radiodiagnosis, Radiation Biology and Radiotherapy Department, College of Medicine, University of Lagos, Lagos 100254, Nigeria
| | - Oluwasegun Joshua Afolaranmi
- Radiodiagnosis, Radiation Biology and Radiotherapy Department, College of Medicine, University of Lagos, Lagos 100254, Nigeria
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17
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Cornes P, Gascon P, Vulto AG, Aapro M. Biosimilar Pegfilgrastim: Improving Access and Optimising Practice to Supportive Care that Enables Cure. BioDrugs 2021; 34:255-263. [PMID: 32232676 PMCID: PMC7211191 DOI: 10.1007/s40259-020-00411-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Febrile neutropenia (FN) is a serious complication of chemotherapy, which can cause significant morbidity and mortality, result in dose delays and reductions and, ultimately, reduce cancer survival. Over the past decade, the availability of biosimilar filgrastim (short-acting granulocyte colony-stimulating factor [G-CSF]) has transformed patient access, with clear evidence of clinical benefit at preventing FN at reduced costs. In 2019, seven biosimilar pegfilgrastims (long-acting G-CSFs) were licensed, creating optimal market conditions and choice for prescribers. FN affects up to 117 per 1000 cancer patients, with mortality rates in the range of 2–21%. By reducing FN incidence and improving chemotherapy relative dose intensity (RDI), G-CSF has been associated with a 3.2% absolute survival benefit. Guidelines recommend primary prophylaxis and that filgrastim be administered for 10–14 days, while pegfilgrastim is administered once per cycle. When taken according to the guidelines, pegfilgrastim and filgrastim are equally effective. However, in routine clinical practice, filgrastim is often under-dosed (< 7 days) and has been shown to be inferior to pegfilgrastim at reducing FN incidence, hospitalisations and maintaining RDI. Once-per-cycle administration with pegfilgrastim might also aid patient adherence. The introduction of biosimilar pegfilgrastim should instigate a rethink of neutropenia management. Biosimilar pegfilgrastim offers countries using biosimilar filgrastim opportunities to improve adherence and thus cancer survival, whilst offering economic benefits for countries using reference pegfilgrastim. These benefits can be realised in full if biosimilar pegfilgrastim becomes part of routine clinical practice supported by drug and therapeutic committees implementing guidelines with multidisciplinary support in the hospital.
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Affiliation(s)
| | - Pere Gascon
- Department of Hematology-Oncology, University of Barcelona, Barcelona, Spain
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Vaud, Switzerland
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18
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Yucel A, Skalicky A, Eseyin OR, Yucel E, Belani R, Bensink M. Development and content validation of the Satisfaction and Experience Questionnaire for Granulocyte Colony-Stimulating Factor (SEQ-G-CSF). J Patient Rep Outcomes 2021; 5:10. [PMID: 33459887 PMCID: PMC7813942 DOI: 10.1186/s41687-020-00277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several options for granulocyte colony-stimulating factor (G-CSF) prophylaxis of chemotherapy-induced febrile neutropenia are available to patients worldwide. We have developed a novel patient-reported outcome measure, the Satisfaction and Experience Questionnaire for G-CSF (SEQ-G-CSF), to help understand patients' perspectives of and satisfaction with different G-CSF options. RESULTS Three oncology nurses and 40 adult oncology patients in the United States were enrolled and participated in focus group discussions to develop and refine the SEQ-G-CSF. Nurses had ≥ 5 years of experience treating oncology patients and were currently involved in the management of oncology patients receiving G-CSF prophylaxis. The patients had breast cancer, lung cancer, non-Hodgkin lymphoma, or prostate cancer (10 patients in each group) and were receiving G-CSF prophylaxis via injection or the on-body injector (OBI) device. The preliminary SEQ-G-CSF contained an item relevance questionnaire and three SEQ modules (sociodemographic, medical history, and G-CSF-related healthcare characteristics questionnaires). Twenty-one patients (53% of total sample size) discussed their experience and satisfaction with G-CSF. Their most common experiences were G-CSF effectiveness, convenience and benefits of the OBI, and relationships with healthcare providers. Side effects and having to undergo additional treatment were also reported. Satisfaction with aspects of G-CSF included the OBI and effectiveness of G-CSF treatment; dissatisfaction included inconvenience (having to return to the clinic the next day and administration of the injection) and the insurance approval process. The SEQ-G-CSF was finalized after three rounds of cognitive interviews and includes five domains related to general satisfaction (one item), treatment burden (four items), travel burden (two items), time burden (four items), and treatment compliance (two items). CONCLUSIONS The SEQ-G-CSF is a novel instrument that quantifies a patient's experience and satisfaction with different G-CSF options using 13 easy-to-understand items. This study provides evidence for the content validity of SEQ-G-CSF. Although further psychometric testing is required, the SEQ-G-CSF may be a useful addition to clinical trials, observational studies, and clinical practice.
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Affiliation(s)
- Aylin Yucel
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | | | | | - Emre Yucel
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | - Rajesh Belani
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | - Mark Bensink
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
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19
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Tanni KA, Truong CB, Almahasis S, Qian J. Safety of Marketed Cancer Supportive Care Biosimilars in the US: A Disproportionality Analysis Using the Food and Drug Administration Adverse Event Reporting System (FAERS) Database. BioDrugs 2021; 35:239-254. [PMID: 33439472 DOI: 10.1007/s40259-020-00466-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Since the approval and availability of the first biosimilar in 2015 in the United States (US), evidence regarding the post-marketing safety of cancer supportive care biosimilars remains limited. OBJECTIVE The aim was to explore the adverse event (AE) reporting patterns and detect disproportionate reporting signals for cancer supportive care biosimilars in the US compared to their originator biologics. METHODS The US Food and Drug Administration Adverse Event Reporting System database (January 1, 2004-March 31, 2020) was used to identify AE reports for filgrastim, pegfilgrastim, and epoetin alpha by type of product (originator biologics vs. biosimilars) and report characteristics. Plots of AE reports against years were used to reveal the reporting patterns. Disproportionality analyses using reporting odds ratios (RORs) were conducted to detect differences in serious and specific AEs between studied drugs and all other drugs. Breslow-Day tests were used to determine homogeneity between the originator biologic-biosimilar pair RORs for the same AE. RESULTS Total numbers of AEs for all studied biosimilars increased after marketing. More AE reports were from female patients for all of the studied drugs. More AEs for originator biologics and filgrastim biosimilar were reported by health professionals, while the highest proportion of reports came from consumers for pegfilgrastim and epoetin alpha biosimilars (29% and 44.1%, respectively). Signals of disproportionate reporting in serious AEs were detected for a pegfilgrastim biosimilar (Fulphila®) compared to its originator biologic. CONCLUSION Our findings support the similarity in the signals of disproportionate reporting between cancer supportive care originator biologics and biosimilars, except for Fulphila®.
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Affiliation(s)
- Kaniz Afroz Tanni
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Cong Bang Truong
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Sura Almahasis
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
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20
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Palukuri NR, Yedla RP, Bala SC, Kuruva SP, Chennamaneni R, Konatam ML, Gundeti S. Incidence of febrile neutropenia with commonly used chemotherapy regimen in localized breast cancer. South Asian J Cancer 2020; 9:4-6. [PMID: 31956608 PMCID: PMC6956592 DOI: 10.4103/sajc.sajc_439_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Breast cancer is the most frequently diagnosed cancer among the women. Most commonly used chemotherapy regimen is Doxorubicin and Cyclophosphamide (AC) which carries significant risk of febrile neutropenia. The aim of the study is to identify the incidence of febrile neutropenia and its effects on the delivery of chemotherapy in patients receiving following AC chemoregimen without primary prophylaxis. Materials and Methods We retrospectively analyzed the case records of the localized breast cancer patients who were treated with AC chemoregimen without primary prophylaxis for febrile neutropenia. Results Between 2013 and 2017, a total of 231 cases received AC chemoregimen. A total of 14 (6.1%) patients were found to have febrile neutropenia. All patients were recovered by day 19 and no deaths were observed. Except for ECOG performance status (P = 0.001) no significant association was found with age, co-morbidities, menopausal status, body surface area and stage of the cancer. There were no treatment delays or dose reductions because of febrile neutropenia. Conclusion The incidence of FN with AC chemotherapy in breast cancer patients is relatively less in the present study. Routine primary prophylaxis is not recommended as this chemotherapy falls in to low risk category for FN but can be considered for patients with ECOG PS > 1. If the diagnosis of febrile neutropenia and institution of appropriate measures are prompt, FN did not affect the delivery of chemotherapy and thus compromise survival.
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Affiliation(s)
- Nageswara Reddy Palukuri
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rajani Priya Yedla
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Stalin Chowdary Bala
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Siva Prasad Kuruva
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rachana Chennamaneni
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Meher Lakshmi Konatam
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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21
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McBride A, Wang W, Campbell K, Balu S, MacDonald K, Abraham I. Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim. J Med Econ 2020; 23:856-863. [PMID: 32323582 DOI: 10.1080/13696998.2020.1760284] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10-100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10-35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3 M (at 15% price discount) to $3 M (35%) at 10% conversion rate and from $6.4 M to $14.9 M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764-5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19-45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6 M (10% conversion) to $23.1 M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.
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Affiliation(s)
- Ali McBride
- Arizona Cancer Center, Banner University Medical Center, Tucson, AZ, USA
- College of Pharmacy, University of Arizona Health Sciences Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Weijia Wang
- Department of Health Economics and Outcome Research, Sandoz Inc, Princeton, NJ, USA
| | - Kim Campbell
- Department of Health Economics and Outcome Research, Sandoz Inc, Princeton, NJ, USA
| | - Sanjeev Balu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Ivo Abraham
- College of Pharmacy, University of Arizona Health Sciences Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science College of Pharmacy, University of Arizona, Tucson, AZ, USA
- MATRIX45, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine College of Medicine - Tucson, University of Arizona, Tucson, AZ, USA
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Khadela A, Vyas B. Assessment of the utilization pattern of chemotherapy agents in patients with head and neck cancer in an oncology hospital. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00732-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hawkins A, Murphy A, McNamara M, Gawade PL, Belani R, Kelsh MA. A Survey of Oncologists' Perceptions and Opinions Regarding the Use of Granulocyte Colony-Stimulating Factors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:178-186. [PMID: 31656028 PMCID: PMC6971139 DOI: 10.1007/s13187-019-01638-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of the study is to describe oncologists' perceptions and opinions about patient eligibility, guidelines, and barriers for use of granulocyte colony-stimulating factor (G-CSF), overall and stratified by their affiliation with the Oncology Care Model (OCM). In May 2018, we invited and recruited practicing US oncologists from a national database for an online survey. Level of agreement was identified using a seven-point scale, ranging from strongly disagree to strongly agree. Of 200 participating oncologists, 70 were OCM-affiliated. Overall, 65% of oncologists agreed or strongly agreed that all patients at high risk of febrile neutropenia (FN) should receive prophylactic G-CSF, and half agreed or strongly agreed that benefits of G-CSF outweigh the potential adverse effects. The most common barriers to G-CSF use for patients at high risk of FN included patient refusal (37.1% of OCM-affiliated oncologists vs. 21.5% of non-OCM-affiliated oncologists), not on protocol/not supported by guidelines (32.9% vs. 23.1%), lack of reimbursement to practice (30.0% vs. 15.4%), and concerns about insurance coverage (22.9% vs. 26.9%). More OCM-affiliated oncologists reported that their practices offer and strongly encourage adherence to a specific protocol for G-CSF use (49.2%) versus non-OCM oncologists (31.3%). Despite recommendations from national guidelines and strong evidence from randomized, controlled clinical trials, only two thirds of oncologists agree or strongly agree that all patients at high risk of FN should receive primary G-CSF prophylaxis. Decisions about G-CSF prophylaxis may be affected by factors other than risk of FN, such as patient choice, practice protocols/guidelines, lack of reimbursement, and insurance coverage.
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Tague LK, Scozzi D, Wallendorf M, Gage BF, Krupnick AS, Kreisel D, Byers D, Hachem R, Gelman AE. Lung transplant outcomes are influenced by severity of neutropenia and granulocyte colony-stimulating factor treatment. Am J Transplant 2020; 20:250-261. [PMID: 31452317 PMCID: PMC6940547 DOI: 10.1111/ajt.15581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 08/01/2019] [Accepted: 08/10/2019] [Indexed: 01/25/2023]
Abstract
Although neutropenia is a common complication after lung transplant, its relationship with recipient outcomes remains understudied. We evaluated a retrospective cohort of 228 adult lung transplant recipients between 2008 and 2013 to assess the association of neutropenia and granulocyte colony-stimulating factor (GCSF) treatment with outcomes. Neutropenia was categorized as mild (absolute neutrophil count 1000-1499), moderate (500-999), or severe (<500) and as a time-varying continuous variable. Associations with survival, acute rejection, and chronic lung allograft dysfunction (CLAD) were assessed with the use of Cox proportional hazards regression. GCSF therapy impact on survival, CLAD, and acute rejection development was analyzed by propensity score matching. Of 228 patients, 101 (42.1%) developed neutropenia. Recipients with severe neutropenia had higher mortality rates than those of recipients with no (adjusted hazard ratio [aHR] 2.97, 95% confidence interval [CI] 1.05-8.41, P = .040), mild (aHR 14.508, 95% CI 1.58-13.34, P = .018), or moderate (aHR 3.27, 95% CI 0.89-12.01, P = .074) neutropenia. Surprisingly, GCSF treatment was associated with a higher risk for CLAD in mildly neutropenic patients (aHR 3.49, 95% CI 0.93-13.04, P = .063), although it did decrease death risk in severely neutropenic patients (aHR 0.24, 95% CI 0.07-0.88, P = .031). Taken together, our data point to an important relationship between neutropenia severity and GCSF treatment in lung transplant outcomes.
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Affiliation(s)
- Laneshia K. Tague
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, St. Louis, Missouri
| | - Davide Scozzi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | | | - Brian F. Gage
- Division of General Medical Sciences, Washington University, St. Louis, Missouri
| | - Alexander S. Krupnick
- Department of Surgery and Carter Center for Immunology, University of Virginia, Charlottesville, Virginia
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | - Derek Byers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, St. Louis, Missouri
| | - Ramsey Hachem
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, St. Louis, Missouri
| | - Andrew E. Gelman
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St. Louis, Missouri
- Department of Pathology & Immunology Washington University, St. Louis, Missouri
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Baig H, Somlo B, Eisen M, Stryker S, Bensink M, Morrow PK. Appropriateness of granulocyte colony-stimulating factor use in patients receiving chemotherapy by febrile neutropenia risk level. J Oncol Pharm Pract 2019; 25:1576-1585. [PMID: 30200842 PMCID: PMC6716357 DOI: 10.1177/1078155218799859] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/11/2018] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Inappropriate granulocyte colony-stimulating factor use with myelosuppressive chemotherapy has been reported. Using the Oncology Services Comprehensive Electronic Records electronic medical record database, prophylactic granulocyte colony-stimulating factor (pegfilgrastim/filgrastim) use in cancer patients was assessed by febrile neutropenia risk level. METHODS Patients with nonmetastatic or metastatic breast, head/neck, colorectal, ovarian/gynecologic, lung cancer, or non-Hodgkin's lymphoma who received myelosuppressive chemotherapy from June 2013 to May 2014 were included. Prophylactic granulocyte colony-stimulating factor use with high-risk, intermediate-risk, and low-risk chemotherapy and distribution of National Comprehensive Cancer Network risk factors with intermediate-risk regimens were assessed. RESULTS Overall, 86,189 patients received ∼4.2 million chemotherapy cycles (high risk, 9%; intermediate risk, 48%; low risk, 43%). Prophylactic granulocyte colony-stimulating factor was given in 24% of cycles (high risk, 59%; intermediate risk, 29%; low risk, 11%). For nonmetastatic solid tumors, granulocyte colony-stimulating factor was given in 78% (high risk), 31% (intermediate risk), and 6% (low risk) of cycles. For metastatic solid tumors or non-Hodgkin's lymphoma, granulocyte colony-stimulating factor was given in 50% (high risk), 27% (intermediate risk), and 11% (low risk) of cycles. Among patients receiving intermediate-risk regimens with granulocyte colony-stimulating factor, febrile neutropenia risk factors were identified in 56% (95% confidence interval, 51.1-60.9%) of patients with nonmetastatic solid tumors (n = 400) and in 70% (64.5-73.5%) of patients with metastatic solid tumors or non-Hodgkin's lymphoma (n = 400). CONCLUSION Prophylactic granulocyte colony-stimulating factor use was appropriately highest for high-risk regimens and lowest for low-risk regimens yet still potentially underused in high risk regimens, overused in low-risk regimens, and not appropriately targeted in intermediate-risk regimens, indicating a need for further education on febrile neutropenia risk evaluation and appropriate granulocyte colony-stimulating factor use.
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Aras E, Bayraktar-Ekincioglu A, Kilickap S. Risk assessment of febrile neutropenia and evaluation of G-CSF use in patients with cancer: a real-life study. Support Care Cancer 2019; 28:691-699. [PMID: 31127438 DOI: 10.1007/s00520-019-04879-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/16/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The guidelines suggest using granulocyte-colony stimulating factor (G-CSF) for febrile neutropenia (FN) as prophylaxis in chemotherapy protocols with the risk of 10-20% after assessment of patient's risk factors. Therefore, the aim of this study is to assess the risk of FN by using the Patient Risk Score (PRS) and evaluating G-CSF use and its side effects by a clinical pharmacist at an outpatient clinic. METHODS The study was conducted from May 2017 until November 2017 at the University Hospital oncology outpatient clinic. Patients who receive chemotherapy protocols with FN risk of 10-20% and > 20% and were initiated G-CSF were included. The patients' risk factors were assessed by the PRS, and the side effects were monitored for 3 months by a clinical pharmacist via a patient self-reported monitoring card. RESULTS A total of 118 patients were included (286 interviews) in the study. There was a significant increase between the first and third visits on the PRS total scores of patients (p = 0.034). The patterns of G-CSF use showed that 34.7% undertreated, 22.8% overtreated, and 42.3% of patients were correctly treated for the prophylaxis. The severity of G-CSF-related musculoskeletal pain was increased on the second and third days of treatment. CONCLUSIONS The use of G-CSFs for FN prophylaxis is recommended; however, there may be a group of patients who are inadequately or unnecessarily treated. Therefore, patients should be assessed for the risk of developing FN in each cycle of chemotherapy and a regular risk assessment by using the PRS can be implemented in the monitoring process.
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Affiliation(s)
- Elif Aras
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Aygin Bayraktar-Ekincioglu
- Faculty of Pharmacy, Department of Clinical Pharmacy, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
| | - Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Oncology Hospital, Sihhiye, Ankara, Turkey
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Van Ryckeghem F, Haverbeke C, Wynendaele W, Jerusalem G, Somers L, Van den Broeck A, Vingerhoedt S, Van Belle S. Real-world use of granulocyte colony-stimulating factor in ambulatory breast cancer patients: a cross-sectional study. Support Care Cancer 2019; 27:1099-1108. [PMID: 30099601 DOI: 10.1007/s00520-018-4399-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To prevent febrile neutropenia (FN), European Organisation for Research and Treatment of Cancer (EORTC) guidelines recommend primary prophylaxis with granulocyte colony-stimulating factors (PPG) for patients at high risk (≥ 20%) of FN. In Belgium, the use of PPG is restricted by specific reimbursement criteria. The impact of these criteria on PPG use and adherence to guidelines is unknown. METHODS This multicentre, cross-sectional, observational study aimed to describe PPG use by FN risk category in breast cancer patients who were scheduled to receive myelosuppressive chemotherapy in outpatient clinics in Belgium during a 2-week period between 13 October and 12 December 2014. RESULTS In total, 490 patients were enrolled. Median age was 57.0 years. Based on their chemotherapy regimen, 53.9, 5.1 and 41.0% of patients were at a low, intermediate and high risk of FN, respectively. Overall, 39.8% of patients received PPG (17.0, 12.0 and 73.1% of those receiving low-, intermediate- and high-risk regimens, respectively). In the high-risk category, PPG was used in 89.9% of dose-dense and in 25.0% of classical chemotherapy regimens. PPG use was adherent to EORTC guidelines in 75.3% of patients (30.6% appropriate use, 44.7% appropriate non-use). EORTC guidelines would recommend PPG use in 46.1% of this study population (n = 226), and its use was reimbursable in Belgium in 76.1% of these patients (n = 172), but only 66.4% of them received PPG (n = 150). CONCLUSIONS Both Belgian reimbursement criteria and physician decision-making led to a proportion of patients for whom PPG treatment was recommended but finally not receiving it.
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Affiliation(s)
| | - Chloë Haverbeke
- Gent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Wim Wynendaele
- Department of Medical Oncology, Imelda Hospital, Bonheiden, Belgium
| | - Guy Jerusalem
- CHU Sart Tilman Liège and University of Liège, Liège, Belgium
| | | | | | | | - Simon Van Belle
- Gent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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The effects of granulocyte colony-stimulating factor on MR images of bone marrow. Skeletal Radiol 2019; 48:209-218. [PMID: 30091008 DOI: 10.1007/s00256-018-3035-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/15/2018] [Accepted: 07/24/2018] [Indexed: 02/02/2023]
Abstract
Granulocyte colony-stimulating factor (G-CSF) analogs such as filgrastim/pegfilgrastim are increasingly used to enhance neutrophilic recovery after chemotherapy. It is widely known that, physiologically, pegfilgrastim stimulates marrow mitotic activity and induces marrow reconversion from fatty to cellular. However, there is limited literature discussing the effects of pegfilgrastim on musculoskeletal magnetic resonance imaging, with the consensus that marrow reconversion secondary to pegfilgrastim therapy is easily confounded with a malignant process, especially in patients with a history of cancer. We attempt to discuss the expected changes and MRI findings after pegfilgrastim therapy through a summary of current literature. Additionally, we provide images from our own practice to support the previously established findings. G-CSF-stimulated reconversion can appear as patchy expansions of baseline hematopoietic marrow, but can also appear to be diffusely homogeneous, adding to its ambiguity. We conclude that using a baseline MRI, clinical information, and assessing sequential MRI changes in conjunction with pegfilgrastim therapy may aid the differentiation between benign and pathological change. We expand our discussion to include the effects of novel technologies, such as whole-body MRI, chemical shift imaging, and contrast agents in helping the distinction.
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Stephens JM, Bensink M, Bowers C, Hollenbeak CS. Risks and consequences of travel burden on prophylactic granulocyte colony-stimulating factor administration and incidence of febrile neutropenia in an aged Medicare population. Curr Med Res Opin 2019; 35:229-240. [PMID: 29661043 DOI: 10.1080/03007995.2018.1465906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Granulocyte colony-stimulating factors (G-CSFs) decrease the incidence of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. This study examines the impact patient travel burden has on administration of prophylactic G-CSFs and the subsequent impact on FN incidence. METHODS Medicare claims data were used to identify a cohort of beneficiaries age 65+ with non-myeloid cancers at high risk for FN between January 2012 and December 2014. Driving distance and time were calculated from patient residence ZIP code to the location of G-CSF and/or chemotherapy administration. Regression models were used to estimate the odds of G-CSF prophylaxis relative to patient driving distance and time, and odds of FN incidence relative to timing of G-CSF administration (optimal [days 2-4 after chemotherapy], sub-optimal [same day], or none). RESULTS The 52,389 study patients had a mean age of 73.5 years, and were 82% female and 89% white race; 49% had female breast cancer, 12% lung cancer, 15% ovarian cancer, and 24% non-Hodgkin's lymphoma. Of these high FN risk patients, 69% had at least one prophylactic G-CSF administration within at least one chemotherapy cycle. The percentage of patients receiving prophylactic G-CSFs in the first cycle was 56%. Median travel time was slightly longer for patients who did not receive G-CSFs and patients receiving short-acting vs long-acting G-CSFs. The odds of receiving no G-CSFs were 26-52% higher (depending on cancer type) for patients with a >80-min one-way travel time, compared to patients traveling <20-min. Concurrently, the odds of FN (using a "narrow" definition) were 18-93% higher for patients who did not receive G-CSFs in the first cycle of chemotherapy. CONCLUSIONS Travel burden, linked to clinic visits for G-CSF administration following myelosuppressive chemotherapy, is associated with sub-optimal use of G-CSF prophylaxis, which may result in a higher incidence of FN.
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Link H, Kerkmann M, Holtmann L, Ortner P. G-CSF guideline adherence in Germany, an update with a retrospective and representative sample survey. Support Care Cancer 2018; 27:1459-1469. [PMID: 30374765 PMCID: PMC6394812 DOI: 10.1007/s00520-018-4481-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023]
Abstract
Background Current guidelines (GL) recommend neutropenia prophylaxis with G-CSF after chemotherapy (CTX) for patients with high (≥ 20%), or, if additional risk factors are present, intermediate (≥ 10–20%) risk of febrile neutropenia. The first sample survey in 2012 (NP1) showed lack of GL adherence. The aim of this second sample survey was to evaluate if GL adherence and implementation have improved. Methods The sample size represented 1.0% of the incidences of lung and 1.1% of breast cancer in Germany in 2010. Data of patients with a febrile neutropenia (FN) risk ≥ 10% who had received at least 2 cycles of chemotherapy between October 2014 and September 2015 was surveyed retrospectively. Results Data from 573 lung cancer (LC) and 801 breast cancer (BC) patients was collected from 109 hospitals and 83 oncology practices with 222 physicians participating. Compared with the NP1 survey, GL adherence increased in LC and FN high-risk (HR) chemotherapy from 15.4 to 47.8% (p < 0.001), and in FN intermediate-risk (IR) chemotherapy from 38.8 to 44.3% (p = 0.003). In BC and FN-HR chemotherapy, GL adherence was unchanged: 85.6% vs. 85.1% (p = 0.73) but increased in FN-IR from 49.3 to 57.8% (p < 0.001). In all IR CTX cycles, there are also no significant differences in GL adherence between the first (51.3%) and subsequent cycles (51.1%; p = 0.948). In LC patients treated in certified or comprehensive cancer centers, the GL adherence in FN-HR chemotherapy was 53.0% vs. 44.9% in other centers (p = 0.295); in FN-IR chemotherapy, it was 45.1% vs. 43.8% (p = 0.750). In BC with FN-HR chemotherapy, GL adherence in certified or comprehensive centers was 85.4% vs. 84.7% in other institutions (p = 0.869); in FN-IR chemotherapy, it was 60.2% vs. 55.0% (p = 0.139). GL adherence in FN-HR chemotherapy and in FN-IR chemotherapy differed between pulmonologists and hematologist-oncologists (FN-HR: 25.0% vs. 43.6%, p < 0.001; 38.1% vs. 48.6%, p < 0.001). Comparing gynecologists with hematologist-oncologists, GL adherence in FN-HR chemotherapy was 86.2% vs. 82.5%. In FN-IR chemotherapy, GL adherence by gynecologists and hematologist-oncologists was 58.6% and 55.6%, respectively (p = 0.288; p = 0.424). Classification and regression tree analysis split pulmonologists and other specialists, with the latter adhering more to GL (p < 0.001). Hematologist-oncologists and gynecologists with more than 2 years of professional training in medical cancer therapy adhered more closely to GL than others (68.7% vs. 46.2%, p < 0.001). Pulmonologists attending ≥ 2 national congresses annually adhered more to guidelines than other pulmonologists (44.8% vs. 24.3%, p < 0.001). Conclusions Adherence to G-CSF GL in Germany has increased but is still insufficient. Certified and comprehensive cancer centers show a higher rate of GL implementation. In GL adherence, there is still a disparity between cancer types and between oncology treatment specialists.
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Affiliation(s)
- Hartmut Link
- Internal Medicine, Hematology and Medical Oncology, Kaiserslautern, Pfaffplatz 10A, 67653, Kaiserslautern, Germany.
| | | | | | - Petra Ortner
- POMME-med GmbH, Von-Erckert-Str. 48, 81827, Munich, Germany
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Morizawa Y, Miyake M, Shimada K, Hori S, Tatsumi Y, Nakai Y, Tanaka N, Fujii T, Fujimoto K. Colony-stimulating factors detected in tumor cells and voided urine are potential prognostic markers for patients with muscle-invasive bladder cancer undergoing radical cystectomy. Res Rep Urol 2018; 10:103-111. [PMID: 30288389 PMCID: PMC6159788 DOI: 10.2147/rru.s166497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background The clinical use of macrophage colony-stimulating factor, granulocyte colony-stimulating factor (G-CSF), and granulocyte macrophage colony-stimulating factor (GM-CSF) has improved the safety of cytotoxic chemotherapy. However, the overexpression of these CSFs in cancers has been reported to be associated with a poor prognosis in various malignancies. We evaluated the potential of CSF expression as a predictor of clinical outcome in patients with muscle-invasive bladder cancer (MIBC). Methods Consecutive patients (n=58) with MIBC who underwent radical cystectomy (RC) were included in this retrospective study. Treatment-naïve tumor specimens obtained by initial transurethral resection of bladder tumors prior to RC were immunostained with antibodies against macrophage colony-stimulating factor, G-CSF, and GM-CSF. We compared the clinicopathological variables and survival between these groups. Baseline levels of CSFs in the serum and voided urine were quantified using an enzyme-linked immunosorbent assay and compared with the expression of CSFs in the tumor lesions. Results Low expression of GM-CSF in the tumor cells was significantly correlated with a pathological T4 category (vs T2–3; P=0.02). In univariate survival analysis, high G-CSF and low GM-CSF expression in the tumor lesion were associated with poor outcomes. Furthermore, Cox proportional regression analysis revealed that high G-CSF and low GM-CSF expression in the tumor were independent predictors of shorter recurrence-free survival, cancer-specific survival, and overall survival. The levels of CSFs in voided urine were associated with the expression of CSFs in the tumor lesions. Conclusion GM-CSF and G-CSF expression in the tumor lesions obtained by initial transurethral resection are independent predictors of poor outcome in MIBC after RC. Levels of G-CSF and GM-CSF in urine before treatment could be useful in prognostication.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan,
| | - Keiji Shimada
- Department of Pathology, Nara City Hospital, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan,
| | | | - Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan,
| | | | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
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Zullo AR, Lou U, Cabral SE, Huynh J, Berard-Collins CM. Overuse and underuse of pegfilgrastim for primary prophylaxis of febrile neutropenia. J Oncol Pharm Pract 2018; 25:1357-1365. [PMID: 30124123 DOI: 10.1177/1078155218792698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Guidelines recommend pegfilgrastim for primary prophylaxis of febrile neutropenia after highly myelosuppressive chemotherapy. While deviations from guidelines could result in overuse and increased costs, underuse is also a concern and could compromise quality of care. Our objectives were to evaluate guideline adherence and quantify the extent to which physician heterogeneity may influence pegfilgrastim use. METHODS We randomly sampled 550 patients from a retrospective cohort of those who received infusions at an academic cancer center between 1 September 2013 and 1 September 2014. Electronic medical and drug dispensing records provided information on patient characteristics, chemotherapy characteristics, prescribing physician, and pegfilgrastim administration. RESULTS We included 154 patients treated by 25 physicians. About half of patients were male and mean age was 61.3 years. Forty (26.1%) patients had no febrile neutropenia risk factors, 62 (40.5%) had one, and 51 (33.3%) had two or more. Thirty patients (19.5%) received pegfilgrastim, of which 12 (40%) received palliative chemotherapy. Nine (60%) of 15 patients on a regimen with a febrile neutropenia risk ≥ 20% received pegfilgrastim. Pegfilgrastim use significantly varied by cancer type (p < 0.01), chemotherapy regimen (p < 0.001), and regimen febrile neutropenia risk (p < 0.001). Multivariable analysis reaffirmed the association between chemotherapy regimen febrile neutropenia risk ≥ 20% and pegfilgrastim use (odds ratio (OR) = 10.1, 95% confidence interval (CI): 1.6-62.7) and suggested that 31% (95% CI: 8%-71%) of the variation in use was attributable to physician characteristics. CONCLUSION Pegfilgrastim was potentially overused for palliative chemotherapy and underused for chemotherapy regimens with febrile neutropenia risk ≥ 20%. Successful interventions to modify prescribing practices likely require an understanding of the relationship between specific physician characteristics and pegfilgrastim use.
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Affiliation(s)
- Andrew R Zullo
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA.,2 Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA.,3 Department of Epidemiology, Brown University, Providence, RI, USA.,4 Providence Veterans Affairs Medical Center, Center of Innovation in Long-Term Services and Supports, Providence, RI, USA
| | - Uvette Lou
- 5 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E Cabral
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Justin Huynh
- 1 Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
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Loupakis F, Stein A, Ychou M, Hermann F, Salud A, Österlund P. A Review of Clinical Studies and Practical Guide for the Administration of Triplet Chemotherapy Regimens with Bevacizumab in First-line Metastatic Colorectal Cancer. Target Oncol 2017; 11:293-308. [PMID: 26687849 PMCID: PMC4901088 DOI: 10.1007/s11523-015-0400-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal cancer is the third most common cancer worldwide. A significant proportion of patients presents with unresectable metastatic disease or develops metachronous metastases following surgical resection of the primary tumor. The prognosis of the disease has improved over the past two decades, with extended multimodality treatment options and the development of increasingly intensified chemotherapy regimens that now typically include targeted biologics. A recent advance in therapy is a treatment regimen composed of three chemotherapeutic agents (i.e., triplet chemotherapy: 5-fluorouracil [5-FU]/leucovorin [LV], oxaliplatin, and irinotecan; FOLFOXIRI) in combination with the vascular endothelial growth factor inhibitor bevacizumab. This regimen has been shown to elicit significantly improved objective response rates and median progression-free survival compared with 5-FU/LV and irinotecan in combination with bevacizumab. However, triplet chemotherapy has been associated with increased rates of chemotherapy-related adverse events, and treatment-emergent adverse events should be properly managed to minimize treatment interruption or discontinuation. We present herein a review of clinical studies evaluating the safety and efficacy of FOLFOXIRI with bevacizumab in metastatic colorectal cancer, and propose a practical guide for the management of adverse events associated with the regimen. ![]()
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Affiliation(s)
- Fotios Loupakis
- Istituto Toscano Tumori, U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126, Pisa, Italy.
| | - Alexander Stein
- University Cancer Center Hamburg, University of Hamburg, Hamburg, Germany
| | - Marc Ychou
- ICM Val d'Aurelle, 34000, Montpellier, France
| | | | - Antonieta Salud
- Department of Medical Oncology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Pia Österlund
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
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Refining the role of pegfilgrastim (a long-acting G-CSF) for prevention of chemotherapy-induced febrile neutropenia: consensus guidance recommendations. Support Care Cancer 2017; 25:3295-3304. [PMID: 28842778 PMCID: PMC5610660 DOI: 10.1007/s00520-017-3842-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/24/2017] [Indexed: 01/09/2023]
Abstract
Purpose Chemotherapy-induced febrile neutropenia (FN) causes treatment delays and interruptions and can have fatal consequences. Current guidelines provide recommendations on granulocyte colony-stimulating factors (G-CSF) for prevention of FN, but guidance is unclear regarding use of short- vs long-acting G-CSF (e.g., filgrastim vs pegfilgrastim/lipegfilgrastim, respectively). An international panel of experts convened to develop guidance on appropriate use of pegfilgrastim for prevention of chemotherapy-induced FN. Methods Guidance recommendations were developed following a literature review, survey, evaluation of current practice, and an expert meeting. Consensus was established using an anonymous Delphi-based approach. Results Guidance recommendations for prevention of treatment-associated FN were as follows: for treatment with curative intent, maintenance of dose intensity using G-CSF to prevent dose delays/reduction should be standard of care; for treatment-associated FN risk ≥ 20%, short-acting G-CSF/pegfilgrastim should be given from cycle 1 onwards; and for treatment-associated FN risk < 20%, short-acting G-CSF/pegfilgrastim should be given if factors suggest overall risk (including treatment-related and patient-related risk factors) is ≥ 20%. It was agreed that pegfilgrastim and 11 days’ filgrastim have similar efficacy and safety and that pegfilgrastim is preferred to < 11 days’ filgrastim (and may be preferred to ≥ 11 days’ filgrastim based on adherence and convenience); pegfilgrastim is not appropriate in weekly chemotherapy; in split-dose chemotherapy, pegfilgrastim is recommended 24 h after last chemotherapy dose; and during palliative chemotherapy, patient adherence and convenience may favor pegfilgrastim. Conclusion In this era of targeted therapies, additional trials with G-CSF are still required. These recommendations should be used with existing guidelines to optimize pegfilgrastim use in clinical practice.
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Adeboyeje G, Agiro A, Malin J, Fisch MJ, DeVries A. Reducing Overuse of Colony-Stimulating Factors in Patients With Lung Cancer Receiving Chemotherapy: Evidence From a Decision Support–Enabled Program. J Oncol Pract 2017; 13:e337-e345. [DOI: 10.1200/jop.2017.020867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Colony-stimulating factors (CSFs) are frequently overused for the primary prevention of febrile neutropenia (FN) in patients receiving chemotherapy. Methods: A retrospective cohort study design was used to analyze commercial claims data in adults with lung cancer initiated on chemotherapy from April 1, 2013, to March 30, 2015. The tool was implemented at oncology practices in phases across 14 US states. Patients were assigned to intervention and nonintervention states according to whether they resided in service areas where the tool had been implemented. Patients were followed up to 6 months after initiating chemotherapy. Difference in pre- and postimplementation CSF use and FN incidence rates were compared with the use of difference-in-differences (DID) models that were adjusted for baseline FN risk factors. Results: The study population of 3,467 patients (intervention states: pre, 707; post, 1,150; nonintervention states: pre, 636; post, 974) showed no significant differences in FN risk factors at baseline. In adjusted results before and after implementation, CSF use decreased from 48.4% to 35.6% in the intervention states versus 43.2% to 44.4% in the nonintervention states (DID, −8.7%; 95% CI, −14.65% to −2.67%; P ≤ .001). The rates of FN were consistent for both groups in both periods, with no statistical difference in trend for the intervention (2.8% to 4.3%) versus the nonintervention (3.1% to 5.1%) states (DID, −0.13; 95% CI, −0.35 to 0.10; P = .927). Conclusion: These findings demonstrate that a decision support-enabled utilization management tool can improve risk-appropriate, guideline-adherent CSF use in patients with lung cancer.
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Affiliation(s)
- Gboyega Adeboyeje
- HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL
| | - Abiy Agiro
- HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL
| | - Jennifer Malin
- HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL
| | - Michael J. Fisch
- HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL
| | - Andrea DeVries
- HealthCore, Wilmington, DE; Anthem, Woodland Hills, CA; and AIM Specialty Health, Deerfield, IL
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Joshi RS, Egbuna OI, Cairns AS, Friedman MJ, Abosaleem B, Reiner MT, Morrow PK. Performance of the pegfilgrastim on-body injector as studied with placebo buffer in healthy volunteers. Curr Med Res Opin 2017; 33:379-384. [PMID: 27819161 DOI: 10.1080/03007995.2016.1257980] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The pegfilgrastim on-body injector (OBI) is a single-use, disposable, battery-powered injector that is designed to automatically deliver a single subcutaneous dose of pegfilgrastim beginning approximately 27 hours after activation and continuing over approximately 45 minutes. In this open-label study, we assessed performance of the OBI delivering placebo buffer in healthy volunteers. RESEARCH DESIGN AND METHODS Healthy men and women aged 18-55 years, with a body mass index of 18-35 kg/m2, were enrolled. OBIs were activated by filling them with placebo buffer, and two injectors were applied concurrently to each subject: one to the abdomen and one to the back of the upper arm. Subjects were monitored for substantial leakage during and after administration. MAIN OUTCOME MEASURES The primary endpoint of the study was successful delivery of placebo buffer based on a composite of the following: no substantial leakage during or after administration, green status light indicator on the injector during and after administration, and fill indicator bar at the empty position after administration. The secondary endpoint was the incidence of treatment-emergent adverse events (AEs). RESULTS Of the 150 subjects enrolled, 149 (99.3%) completed the study. Study subjects were 48.0% men, and 52.0% women; 47.3% were white, 35.3% black or African American, 12.7% Asian, and 4.7% other. Mean (SD) age was 35.9 (10.8) years. Of the 297 total deliveries, 292 (98.3%) were considered successful: 147/149 (98.7%; 95% confidence interval [CI]: 95.2%-99.6%) to the abdomen and 145/148 (98.0%; 95% CI: 94.2%-99.3%) to the back of the upper arm. Five deliveries were considered unsuccessful: two due to hazard alarms, and three due to substantial leakage. The most common treatment-emergent AEs (in >2% of subjects overall) by preferred term were medical device site reaction (20.7%), catheter-site hemorrhage (8.7%), and headache (3.3%). No serious AEs were reported. CONCLUSIONS The pegfilgrastim OBI was well tolerated, and deliveries of placebo buffer were successful 98.3% of the time. The generalizability of these results may be limited by the conduct of this study in healthy subjects in a controlled environment.
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Affiliation(s)
| | - Ogo I Egbuna
- a Medical Sciences, Amgen Inc. , Thousand Oaks , CA , USA
| | - Alex S Cairns
- b Global Operations, Amgen Inc. , Thousand Oaks , CA , USA
| | | | | | - Maureen T Reiner
- d Global Biostatistical Science, Amgen Inc. , Thousand Oaks , CA , USA
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Altmeier S, Toska A, Sparber F, Teijeira A, Halin C, LeibundGut-Landmann S. IL-1 Coordinates the Neutrophil Response to C. albicans in the Oral Mucosa. PLoS Pathog 2016; 12:e1005882. [PMID: 27632536 PMCID: PMC5025078 DOI: 10.1371/journal.ppat.1005882] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/19/2016] [Indexed: 12/18/2022] Open
Abstract
Mucosal infections with Candida albicans belong to the most frequent forms of fungal diseases. Host protection is conferred by cellular immunity; however, the induction of antifungal immunity is not well understood. Using a mouse model of oropharyngeal candidiasis (OPC) we show that interleukin-1 receptor (IL-1R) signaling is critical for fungal control at the onset of infection through its impact on neutrophils at two levels. We demonstrate that both the recruitment of circulating neutrophils to the site of infection and the mobilization of newly generated neutrophils from the bone marrow depended on IL-1R. Consistently, IL-1R-deficient mice displayed impaired chemokine production at the site of infection and defective secretion of granulocyte colony-stimulating factor (G-CSF) in the circulation in response to C. albicans. Strikingly, endothelial cells were identified as the primary cellular source of G-CSF during OPC, which responded to IL-1α that was released from keratinocytes in the infected tissue. The IL-1-dependent crosstalk between two different cellular subsets of the nonhematopoietic compartment was confirmed in vitro using a novel murine tongue-derived keratinocyte cell line and an established endothelial cell line. These data establish a new link between IL-1 and granulopoiesis in the context of fungal infection. Together, we identified two complementary mechanisms coordinating the neutrophil response in the oral mucosa, which is critical for preventing fungal growth and dissemination, and thus protects the host from disease. The opportunistic pathogen Candida albicans is a major risk factor for immunosuppressed individuals, and oropharyngeal candidiasis (OPC) is a frequent complication in patients with weakened cellular immunity. The cytokine interleukin-17 (IL-17) plays a critical role for antifungal host defense and was proposed to act by regulating neutrophil recruitment to the oral mucosa. However, although IL-17 can promote neutrophil trafficking in some situations, we recently showed in a mouse model that this is not the case during OPC. Thus, the mechanism governing the neutrophil response to C. albicans remained to be determined. Here, we demonstrate an essential role of IL-1 receptor (IL-1R) signaling in the recruitment of neutrophils from the circulation to the infected tissue via enhanced secretion of chemokines and increased output of neutrophils from the bone marrow. We found that IL-1α is released from keratinocytes upon invasion of C. albicans and acts on endothelial cells to induce the production of granulocyte colony-stimulating factor (G-CSF), a key trigger of emergency granulopoiesis. Thereby, IL-1R signaling translates the local response to the fungus in the oral mucosa into a systemic response that critically contributes to protection from infection.
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Affiliation(s)
- Simon Altmeier
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Albulena Toska
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Florian Sparber
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Alvaro Teijeira
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zürich, Switzerland
| | - Cornelia Halin
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zürich, Switzerland
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Smith TJ, Hillner BE. Real-World Conundrums and Biases in the Use of White Cell Growth Factors. Am Soc Clin Oncol Educ Book 2016; 35:e524-7. [PMID: 27249762 DOI: 10.1200/edbk_156062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We present the 2015 American Society of Clinical Oncology (ASCO) white cell growth factors, or colony-stimulating factor (CSF), guidelines, updated from 2006. One new indication has been added-dose-intense chemotherapy for bladder cancer-to accompany the existing use for dose-dense breast cancer chemotherapy. Colony-stimulating factors remain appropriate for any regimen where the risk of febrile neutropenia is about 20% per cycle and dose reduction is not appropriate. Based on new evidence from multiple trials, CSF use is no longer indicated in treatment of lymphoma unless there are special risk factors. The United States accounts for 78% of the sales of CSF. The panel approved the use of all biosimilars, but the cost savings will be small as the price is about 80% of the branded CSFs. More biosimilars at lower cost are awaited. Methods to reduce use without harm to patients, by requiring justification according to accepted guidelines, are ongoing.
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Affiliation(s)
- Thomas J Smith
- From the Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Hillner Consulting, LLC, Richmond, VA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Bruce E Hillner
- From the Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Hillner Consulting, LLC, Richmond, VA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
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Matikas A, Georgoulias V, Kotsakis A. Emerging agents for the prevention of treatment induced neutropenia in adult cancer patients. Expert Opin Emerg Drugs 2016; 21:157-66. [PMID: 27139914 DOI: 10.1080/14728214.2016.1184646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The administration of myeloid growth factors is the only approved treatment for the prevention of chemotherapy induced neutropenia and febrile neutropenia. However, their specific indications and contraindications and potential side effects limit their application to only a relatively small subset of patients at the highest risk for complications, such as infection. AREAS COVERED A computerized systematic literature search was performed through Medline, Google Scholar, Cochrane Library, the Pharmaprojects database and the clinicaltrials.gov website. The shortcomings of the existing treatment approach are reviewed, along with a synopsis of the characteristics of novel agents that protect bone marrow progenitors from the cytotoxic effects of antineoplastic treatment that may be used in the future as a stand-alone preventive strategy or as an adjunct to growth factors. EXPERT OPINION There is an abundance of agents undergoing evaluation for the prevention of treatment-induced neutropenia. The appropriate selection of patients, the optimization of the use of existing agents and the increasing competition from biosimilars which likely ensure future decreases in healthcare costs are essential for growth factors to retain their dominant position in this setting.
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Affiliation(s)
- Alexios Matikas
- a Department of Medical Oncology , University General Hospital of Heraklion , Heraklion , Greece.,b Hellenic Oncology Research Group (HORG) , Athens , Greece
| | - Vassilis Georgoulias
- b Hellenic Oncology Research Group (HORG) , Athens , Greece.,c Department of Medical Oncology , IASO General , Athens , Greece
| | - Athanasios Kotsakis
- a Department of Medical Oncology , University General Hospital of Heraklion , Heraklion , Greece.,b Hellenic Oncology Research Group (HORG) , Athens , Greece
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Stephens JM, Li X, Reiner M, Tzivelekis S. Annual patient and caregiver burden of oncology clinic visits for granulocyte-colony stimulating factor therapy in the US. J Med Econ 2016; 19:537-47. [PMID: 26745764 DOI: 10.3111/13696998.2016.1140052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs) is indicated for chemotherapy patients with a significant risk of febrile neutropenia. This study estimates the annual economic burden on patients and caregivers of clinic visits for prophylactic G-CSF injections in the US. METHODS Annual clinic visits for prophylactic G-CSF injections (all cancers) were estimated from national cancer incidence, chemotherapy treatment and G-CSF utilization data, and G-CSF sales and pricing information. Patient travel times, plus time spent in the clinic, were estimated from patient survey responses collected during a large prospective cohort study (the Prospective Study of the Relationship between Chemotherapy Dose Intensity and Mortality in Early-Stage (I-III) Breast Cancer Patients). Economic models were created to estimate travel costs, patient co-pays and the economic value of time spent by patients and caregivers in G-CSF clinic visits. RESULTS Estimated total clinic visits for prophylactic G-CSF injections in the US were 1.713 million for 2015. Mean (SD) travel time per visit was 62 (50) min; mean (SD) time in the clinic was 41 (68) min. Total annual time for travel to and from the clinic, plus time at the clinic, is estimated at 4.9 million hours, with patient and caregiver time valued at $91.8 million ($228 per patient). The estimated cumulative annual travel distance for G-CSF visits is 60.2 million miles, with a total transportation cost of $28.9 million ($72 per patient). Estimated patient co-pays were $61.1 million, ∼$36 per visit, $152 per patient. The total yearly economic impact on patients and caregivers is $182 million, ∼$450 per patient. LIMITATIONS Data to support model parameters were limited. Study estimates are sensitive to the assumptions used. CONCLUSIONS The burden of clinic visits for G-CSF therapy is a significant addition to the total economic burden borne by cancer patients and their families.
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Affiliation(s)
- J Mark Stephens
- a a Prima Health Analytics, Health Economics , Weymouth, MA , USA
| | - Xiaoyan Li
- b b Global Health Economics, Amgen Inc. , Thousand Oaks, CA , USA
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Cetean S, Căinap C, Constantin AM, Căinap S, Gherman A, Oprean L, Hangan A, Oprean R. The importance of the granulocyte-colony stimulating factor in oncology. ACTA ACUST UNITED AC 2015; 88:468-72. [PMID: 26732055 PMCID: PMC4689238 DOI: 10.15386/cjmed-531] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 12/24/2022]
Abstract
Granulocyte-colony stimulating factor (G-CSF) is a glycoprotein, the second CSF, sharing some common effects with granulocyte macrophage-colony stimulating factor (GM-CSF), interleukin-3 (IL-3) and interleukin-5 (IL-5). G-CSF is mainly produced by fibroblasts and endothelial cells from bone marrow stroma and by immunocompetent cells (monocytes, macrophages). The receptor for G-CSF (G-CSFR) is part of the cytokine and hematopoietin receptor superfamily and G-CSFR mutations cause severe congenital neutropenia. The main action of G-CSF - G-CSFR linkage is stimulation of the production, mobilization, survival and chemotaxis of neutrophils, but there are many other G-CSF effects: growth and migration of endothelial cells, decrease of norepinephrine reuptake, increase in osteoclastic activity and decrease in osteoblast activity. In oncology, G-CSF is utilized especially for the primary prophylaxis of chemotherapy-induced neutropenia, but it can be used for hematopoietic stem cell transplantation, it can produce monocytic differentiation of some myeloid leukemias and it can increase some drug resistance. The therapeutic indications of G-CSF are becoming more and more numerous: non neutropenic patients infections, reproductive medicine, neurological disturbances, regeneration therapy after acute myocardial infarction and of skeletal muscle, and hepatitis C therapy.
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Affiliation(s)
- Sînziana Cetean
- Department of General and Inorganic Chemistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Prof. Dr. Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Călin Căinap
- Prof. Dr. Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania; Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anne-Marie Constantin
- Department of Morphological Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Căinap
- Department of Infant Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandra Gherman
- Prof. Dr. Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania; Department of Oncology and Radiotherapy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luminiţa Oprean
- Department of General and Inorganic Chemistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adriana Hangan
- Department of General and Inorganic Chemistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Oprean
- Department of Analytical Chemistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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El-Akabawy G, El-Mehi A. Mobilization of endogenous bone marrow-derived stem cells in a thioacetamide-induced mouse model of liver fibrosis. Tissue Cell 2015; 47:257-65. [PMID: 25857836 DOI: 10.1016/j.tice.2015.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/01/2015] [Accepted: 03/03/2015] [Indexed: 02/07/2023]
Abstract
The clinical significance of enhancing endogenous circulating haematopoietic stem cells is becoming increasingly recognized, and the augmentation of circulating stem cells using granulocyte-colony stimulating factor (G-CSF) has led to promising preclinical and clinical results for several liver fibrotic conditions. However, this approach is largely limited by cost and the infeasibility of maintaining long-term administration. Preclinical studies have reported that StemEnhance, a mild haematopoietic stem cell mobilizer, promotes cardiac muscle regeneration and remedies the manifestation of diabetes. However, the effectiveness of StemEnhance in ameliorating liver cirrhosis has not been studied. This study is the first to evaluate the beneficial effect of StemEnhance administration in a thioacetamide-induced mouse model of liver fibrosis. StemEnhance augmented the number of peripheral CD34-positive cells, reduced hepatic fibrosis, improved histopathological changes, and induced endogenous liver proliferation. In addition, VEGF expression was up-regulated, while TNF-α expression was down-regulated in thioacetamide-induced fibrotic livers after StemEnhance intake. These data suggest that StemEnhance may be useful as a potential therapeutic candidate for liver fibrosis by inducing reparative effects via mobilization of haematopoietic stem cells.
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Affiliation(s)
- Gehan El-Akabawy
- Menoufia University, Department of Anatomy and Embryology, Faculty of Medicine, Egypt.
| | - Abeer El-Mehi
- Menoufia University, Department of Anatomy and Embryology, Faculty of Medicine, Egypt
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