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Phelip JM, Souquet PJ, Hacini M, Chehimi M, Bourgeois V, Bennoune R, Tredan O. G-CSF filgrastim biosimilar-Sandoz reduces the incidence of febrile neutropenia in patients receiving chemotherapy regimens with rest periods not exceeding 14 days: A French, multicenter, prospective, non-interventional study. Cancer Treat Res Commun 2023; 35:100690. [PMID: 36780734 DOI: 10.1016/j.ctarc.2023.100690] [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: 12/08/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The objective of this study was to describe filgrastim biosimilar-Sandoz modalities of use in patients receiving cytotoxic chemotherapy regimens with a rest period of ≤14 days and to investigate the incidence of febrile neutropenia (FN) in routine clinical practice. METHODS This was a French, multicenter, prospective and descriptive, non-interventional study including patients with breast, lung, gastrointestinal cancer or a lymphoma initiating filgrastim biosimilar-Sandoz treatment and in the context of cytotoxic chemotherapy with a rest period not exceeding 14 days. Data were collected during two routine clinical visits on the modalities of use of filgrastim biosimilar-Sandoz, on the incidence of neutropenia events and on adverse events. RESULTS Between November 2015 and June 2018, 1080 patients were enrolled in the study in 129 centers. Overall, 941 patients were evaluable for efficacy and 937 for safety. Of the 941 patients, 84.8% had a solid tumor and 15.2% had a lymphoid hemopathy. Filgrastim biosimilar-Sandoz was prescribed as primary prophylaxis in 74.0% of the patients and as secondary prophylaxis in 22.4% of the patients. FN was reported in 1.5% of patients with a solid tumor and 12.6% of patients with a lymphoma. A chemotherapy relative dose intensity of over 85% with regard to the reference dose was achieved by more than 80% of the patients in all tumor localizations. CONCLUSIONS The study showed that filgrastim biosimilar-Sandoz is safe to use and effective in preventing FN and in allowing to maintain the dose intensity of chemotherapy.
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Affiliation(s)
- Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Pierre-Jean Souquet
- Department of Thoracic Cancer, University Hospital of Lyon, Institut de Cancérologie des Hospices Civils de Lyon, Lyon 69002, France
| | - Maya Hacini
- Department of Hematology, Centre Hospitalier de Chambéry, Chambery 73000, France
| | - Mohamad Chehimi
- Department of Medical Oncology and Hematology, Centre Hospitalier Saint Quentin Cedex, 02321 Saint-Quentin, France
| | - Vincent Bourgeois
- Department of Oncology, Centre Hospitalier de Boulogne sur mer, 62321 Boulogne-sur-mer, France
| | - Ryma Bennoune
- Medical Department, Oncology, Sandoz SAS, 92593 Levallois-Perret Cedex, France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69373, Lyon Cedex, France.
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Ludwig H, Bokemeyer C, Aapro M, Boccadoro M, Gascón P, Denhaerynck K, Krendyukov A, Abraham I, MacDonald K. Chemotherapy-induced neutropenia/febrile neutropenia prophylaxis with biosimilar filgrastim in solid tumors versus hematological malignancies: MONITOR-GCSF study. Future Oncol 2019; 15:897-907. [DOI: 10.2217/fon-2018-0814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: This study aimed to report patterns of biosimilar filgrastim prophylaxis and outcomes of chemotherapy-induced neutropenia (CIN)/febrile neutropenia (FN) in patients with hematological malignancies or solid tumors. Patients & methods: MONITOR-GCSF is a real-world study of 1447 cancer patients receiving CIN/FN prophylaxis with biosimilar filgrastim (solid tumors: 77.2%; hematological malignancies: 22.8%). Results: Differences in prophylaxis intensity and day of initiation relative to guideline recommendations were observed. In hematology patients, higher rates of CIN and FN occurred at cycle level, and rate of FN was higher at patient level (9.1 vs 5.0% in solid tumor patients). Conclusion: Adequate GCSF support in hematology and solid tumor patients is important to prevent CIN/FN and related hospitalizations and chemotherapy disturbances.
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Affiliation(s)
- Heinz Ludwig
- Medizinische Abteilung I – Onkologie und Haematologie, Wilhelminenspital, Wienpäoh, Montleartstraße 37, 1160 Vienna, Austria
| | - Carsten Bokemeyer
- Department of Oncology, Hematology & BMT with Section of Pneumology Universitaetsklinikum Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Route du Muids 3, 1272 Genolier, Switzerland
| | - Mario Boccadoro
- Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S Giovanni Battista di Torino, Via Cherasco 15, 10126 Torino, Italy
| | - Pere Gascón
- Department of Hematology–Oncology, Division of Medical Oncology, Hospital Clínic de Barcelona, University of Barcelona, Carrer de Villarroel 170, 08036 Barcelona, Spain
| | - Kris Denhaerynck
- Matrix45, Tucson, 6159 West Sunset Road, Tucson, AZ 85743, USA
- Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Andriy Krendyukov
- Hematology and Oncology, Hexal AG, Industriestraße 25, 83607 Holzkirchen, Germany (formerly)
| | - Ivo Abraham
- Matrix45, Tucson, 6159 West Sunset Road, Tucson, AZ 85743, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- Center for Health Outcomes & PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Karen MacDonald
- Matrix45, Tucson, 6159 West Sunset Road, Tucson, AZ 85743, USA
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Prognostic value of granulocyte colony-stimulating factor in patients with non-metastatic clear cell renal cell carcinoma. Oncotarget 2017; 8:69961-69971. [PMID: 29050255 PMCID: PMC5642530 DOI: 10.18632/oncotarget.19540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/20/2017] [Indexed: 01/04/2023] Open
Abstract
Granulocyte colony-stimulating factor is a well-known cytokine to stimulate inflammatory cells. We sought to investigate the prognostic value of its expression in patients with non-metastatic clear cell renal cell carcinoma. Enrolled in this study were 228 eligible patients treated with curative nephrectomy for clear cell renal cell carcinoma during 2008. Granulocyte colony-stimulating factor expression was detected by immunohistochemistry in patient specimens, and was divided into three groups according to the distribution of its immunohistochemistry score. Subgroup analyses were performed to evaluate its risk stratification ability. Cox regression models were applied to analyze the impact of prognostic factors. We found that high granulocyte colony-stimulating factor expression was associated with diminished recurrence-free survival (P<0.001). Its expression had stronger stratification ability in late disease patients, and was further identified as an independent prognosticator for recurrence-free survival. Moreover, nomogram based on granulocyte colony-stimulating factor expression presented a better prognostic ability compared with current prognostic systems (the concordance index = 0.874). To conclude, intratumoal granulocyte colony-stimulating factor expression could be a potential prognosticator for recurrence-free survival in non-metastatic clear cell renal cell carcinoma patients. Incorporating its expression into other pathologic factors provided a finer individual model for non-metastatic clear cell renal cell patients.
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Bokemeyer C, Gascón P, Aapro M, Ludwig H, Boccadoro M, Denhaerynck K, Gorray M, Krendyukov A, Abraham I, MacDonald K. Over- and under-prophylaxis for chemotherapy-induced (febrile) neutropenia relative to evidence-based guidelines is associated with differences in outcomes: findings from the MONITOR-GCSF study. Support Care Cancer 2017; 25:1819-1828. [PMID: 28111718 PMCID: PMC5403842 DOI: 10.1007/s00520-017-3572-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE In the MONITOR-GCSF study of chemotherapy-induced (febrile) neutropenia with biosimilar filgrastim, 56.6% of patients were prophylacted according to amended EORTC guidelines, but 17.4% were prophylacted below and 26.0% above guideline recommendations. METHODS MONITOR-GCSF is a prospective, observational study of 1447 evaluable patients from 140 cancers centers in 12 European countries treated with myelosuppressive chemotherapy for up to 6 cycles receiving biosimilar GCSF prophylaxis. Patients were classified as under-, correctly-, or over-prophylacted with GCSF relative to guideline recommendations based on their chemotherapy risk, individual risk factors, and type of GCSF prophylaxis (primary versus secondary). RESULTS Differences between under- (17.4%), correctly- (56.6%), or over-prophylacted (26.0%) groups were found in terms of patient risk factors (age, performance status, history of FN, comorbid conditions) as well as prophylaxis patterns (type of prophylaxis, day of GCSF initiation, and GCSF duration). Rates of chemotherapy-induced neutropenia (CIN) (all grades), FN, and CIN-related hospitalizations were consistently lower in over-prophylacted patients relative to under- and correctly-prophylacted patients. No differences were observed between under- and correctly-prophylacted patients except for CIN/FN-related chemotherapy disturbances. No GCSF safety differences were found between groups (except for headaches). CONCLUSIONS The real-world evidence provided by the MONITOR-GCSF study indicates that providing GCSF support may yield better CIN, FN, and CIN/FN-related hospitalization outcomes if patients are prophylacted at levels above guideline recommendations. Patients who are under-prophylacted are at higher risk for disturbances to their chemotherapy regimens. Our findings support the guideline recommendation that CIN/FN risk be assessed at the beginning of each chemotherapy cycle.
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Affiliation(s)
| | - Pere Gascón
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - Heinz Ludwig
- Medizinische Abteilung I - Onkologie und Haematologie, Wilhelminenspital, Wien, Austria
| | - Mario Boccadoro
- Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy
| | - Kris Denhaerynck
- Matrix45, 6159 W Sunset Rd, Tucson, AZ, 85743, USA
- Universitaet Basel, Basel, Switzerland
| | | | | | - Ivo Abraham
- Matrix45, 6159 W Sunset Rd, Tucson, AZ, 85743, USA.
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.
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Aapro M, Bokemeyer C, Ludwig H, Gascón P, Boccadoro M, Denhaerynck K, Gorray M, Krendyukov A, MacDonald K, Abraham I. Chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim in elderly versus non-elderly cancer patients: Patterns, outcomes, and determinants (MONITOR-GCSF study). J Geriatr Oncol 2016; 8:86-95. [PMID: 27829539 DOI: 10.1016/j.jgo.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/22/2016] [Accepted: 09/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myelotoxic chemotherapy is associated with chemotherapy-induced (febrile) neutropenia (CIN/FN). The MONITOR-GCSF study evaluated biosimilar filgrastim (Zarzio®) prophylaxis patterns, associated outcomes, and determinants. We performed stratified analyses comparing elderly and non-elderly patients. METHODS Comparative (elderly/non-elderly) analysis of demographics and clinical status, prophylaxis, associated CIN/FN outcomes (CIN grade 4 [CIN4], FN, CIN/FN-related hospitalizations and chemodisturbances, composite), and, per hierarchical modeling, determinants thereof evaluated at the patient- and cycle-level. RESULTS There were no significant differences between both cohorts in prophylaxis initiation/duration and associated outcomes, but proportionately more elderly patients were correctly-prophylacted and fewer over-prophylacted. Common determinants of poor CIN/FN outcomes included concomitant antibiotic prophylaxis, impaired performance status, and any grade CIN in a previous cycle, whereas common determinants of good outcomes included over-prophylaxis and prophylaxis initiation within 24-72h. In the elderly, female gender, liver/renal/cardiovascular disease, secondary prophylaxis, and under-prophylaxis were associated with poorer outcomes. In the non-elderly, CIN4 at baseline or in a prior cycle was associated with poorer CIN/FN outcomes, and higher biosimilar filgrastim dose and, perhaps counter-intuitively, under-prophylaxis with better outcomes. CONCLUSION Adequate GCSF support is essential for all patients, but especially for elderly patients with serious chronic disease, certainly, if concomitant antibiotic prophylaxis is indicated and if a CIN4 episode occurred in a prior cycle. The potential impact of impaired performance status, especially ECOG≥2 at chemotherapy start or a worsening to such during chemotherapy; under-prophylaxis, including inadequate secondary prophylaxis, should be considered in elderly patients. Timely GCSF initiation and over-prophylaxis is associated with lower rates of adverse CIN/FN events in elderly and non-elderly patients, and should be further evaluated in prospective randomized trials.
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Affiliation(s)
- Matti Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland.
| | | | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Wien, Austria
| | - Pere Gascón
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Mario Boccadoro
- Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy
| | - Kris Denhaerynck
- Matrix45, Tucson, AZ, USA; Universitaet Basel, Basel, Switzerland
| | | | | | | | - Ivo Abraham
- Matrix45, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
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Aapro M, Ludwig H, Bokemeyer C, Gascón P, Boccadoro M, Denhaerynck K, Krendyukov A, Gorray M, MacDonald K, Abraham I. Predictive modeling of the outcomes of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim (MONITOR-GCSF study). Ann Oncol 2016; 27:2039-2045. [PMID: 27793849 PMCID: PMC5091320 DOI: 10.1093/annonc/mdw309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Risk models of chemotherapy-induced (CIN) and febrile neutropenia (FN) have to date focused on determinants measured at the start of chemotherapy. We extended this static approach with a dynamic approach of CIN/FN risk modeling at the start of each cycle. DESIGN We applied predictive modeling using multivariate logistic regression to identify determinants of CIN/FN episodes and related hospitalizations and chemotherapy disturbances (CIN/FN consequences) in analyses at the patient ('ever' during the whole period of chemotherapy) and cycle-level (during a given chemotherapy cycle). Statistical dependence of cycle data being 'nested' under patients was managed using generalized estimation equations. Predictive performance of each model was evaluated using bootstrapped c concordance statistics. RESULTS Static patient-level risk models of 'ever' experiencing CIN/FN adverse events and consequences during a planned chemotherapy regimen included predictors related to history, risk factors, and prophylaxis initiation and intensity. Dynamic cycle-level risk models of experiencing CIN/FN adverse events and consequences in an upcoming cycle included predictors related to history, risk factors, and prophylaxis initiation and intensity; as well as prophylaxis duration, CIN/FN in prior cycle, and treatment center characteristics. CONCLUSIONS These 'real-world evidence' models provide clinicians with the ability to anticipate CIN/FN adverse events and their consequences at the start of a chemotherapy line (static models); and, innovatively, to assess risk of CIN/FN adverse events and their consequences at the start of each cycle (dynamic models). This enables individualized patient treatment and is consistent with the EORTC recommendation to re-appraise CIN/FN risk at the start of each cycle. Prophylaxis intensity (under-, correctly-, or over-prophylacted relative to current EORTC guidelines) is a major determinant. Under-prophylaxis is clinically unsafe. Over-prophylaxis of patients administered chemotherapy with intermediate or low myelotoxicity levels may be beneficial, both in patients with and without risk factors, and must be validated in future studies.
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Affiliation(s)
- M Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - H Ludwig
- Medizinische Abteilung I-Oncology and Hematology, Wilhelminenspital, Wien, Austria
| | - C Bokemeyer
- Department of Oncology, Universitaetsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - P Gascón
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Boccadoro
- Department of Oncology and Hematology, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy
| | - K Denhaerynck
- Matrix45, Tucson, AZ, USA
- Department of Statistics, Universitaet Basel, Basel, Switzerland
| | | | | | | | - I Abraham
- Matrix45, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
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Treatment patterns and outcomes in the prophylaxis of chemotherapy-induced (febrile) neutropenia with biosimilar filgrastim (the MONITOR-GCSF study). Support Care Cancer 2015; 24:911-925. [DOI: 10.1007/s00520-015-2861-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/17/2015] [Indexed: 12/24/2022]
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Barnes G, Pathak A, Schwartzberg L. G-CSF utilization rate and prescribing patterns in United States: associations between physician and patient factors and GCSF use. Cancer Med 2014; 3:1477-84. [PMID: 25410813 PMCID: PMC4298373 DOI: 10.1002/cam4.344] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/16/2014] [Accepted: 08/15/2014] [Indexed: 12/22/2022] Open
Abstract
Febrile neutropenia (FN) is a common complication among patients with chemotherapy-induced myelotoxicity and is associated with a number of negative outcomes including prolonged hospitalization, increased medical costs, increased risk of mortality, dose reductions, and delays. Granulocyte-colony-stimulating factor (G-CSF), granulocyte-macrophage-colony stimulating factor (GM-CSF), and pegylated G-CSF are effective at reducing risk and duration of neutropenia-related events. However, despite guidelines, the use of G-CSF and pegylated G-CSF in the United States has not been consistent and pattern of care studies have focused primarily on G-CSF. A number of studies found that G-CSF is underutilized in patients undergoing chemotherapy treatments associated with a high risk of FN, while being over utilized in patients with a low-risk FN. Wide variations in overuse, underuse, and misuse of G-CSF are associated with a number of physician and patient factors. Improved awareness of the guidelines, feedback to providers regarding proper usage, and understanding of chemotherapy regimens associated with very low risks as well as high risks (>20%) of FN is some of the approaches that could lead to improving care.
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Affiliation(s)
- Gisoo Barnes
- Teva Pharmaceuticals41 Moores Rd., Frazer, Pennsylvania, 19355
| | - Ashutosh Pathak
- Teva Pharmaceuticals41 Moores Rd., Frazer, Pennsylvania, 19355
| | - Lee Schwartzberg
- The West Clinic100 N. Humphreys Blvd., Memphis, Tennessee, 38120
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A prospectively validated nomogram for predicting the risk of chemotherapy-induced febrile neutropenia: a multicenter study. Support Care Cancer 2014; 23:1759-67. [PMID: 25433439 DOI: 10.1007/s00520-014-2531-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 11/17/2014] [Indexed: 01/21/2023]
Abstract
PURPOSE There is clinical need to predict risk of febrile neutropenia before a specific cycle of chemotherapy in cancer patients. METHODS Data on 3882 chemotherapy cycles in 1089 consecutive patients with lung, breast, and colon cancer from four teaching hospitals were used to construct a predictive model for febrile neutropenia. A final nomogram derived from the multivariate predictive model was prospectively confirmed in a second cohort of 960 consecutive cases and 1444 cycles. RESULTS The following factors were used to construct the nomogram: previous history of febrile neutropenia, pre-cycle lymphocyte count, type of cancer, cycle of current chemotherapy, and patient age. The predictive model had a concordance index of 0.95 (95 % confidence interval (CI) = 0.91-0.99) in the derivation cohort and 0.85 (95 % CI = 0.80-0.91) in the external validation cohort. A threshold of 15 % for the risk of febrile neutropenia in the derivation cohort was associated with a sensitivity of 0.76 and specificity of 0.98. These figures were 1.00 and 0.49 in the validation cohort if a risk threshold of 50 % was chosen. CONCLUSIONS This nomogram is helpful in the prediction of febrile neutropenia after chemotherapy in patients with lung, breast, and colon cancer. Usage of this nomogram may help decrease the morbidity and mortality associated with febrile neutropenia and deserves further validation.
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Granulocyte colony-stimulating factors as prophylaxis against febrile neutropenia. Support Care Cancer 2014; 23:547-59. [PMID: 25284722 DOI: 10.1007/s00520-014-2459-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
Myelosuppression secondary to chemotherapy remains a serious adverse effect of cancer therapy that causes high morbidity and mortality. Several current European and American guidelines recommend consideration of primary prophylaxis with colony-stimulating factors (CSFs) when the risk of febrile neutropenia is higher than 20 %. The main factors associated with a high risk of febrile neutropenia include the chemotherapy regimen, tumor type, and patient-related factors such as old age and/or comorbidities. The purpose of this paper is to summarize the most relevant clinical trials and updated recommendations of the main guidelines on the role of granulocyte colony-stimulating factors (G-CSFs) in febrile neutropenia, examining whether the combination of G-CSF with chemotherapy improves overall survival. Future directions for G-CSF use are also discussed.
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Dobrenis K, Gauthier LR, Barroca V, Magnon C. Granulocyte colony-stimulating factor off-target effect on nerve outgrowth promotes prostate cancer development. Int J Cancer 2014; 136:982-8. [PMID: 24975135 DOI: 10.1002/ijc.29046] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/13/2014] [Indexed: 02/03/2023]
Abstract
The hematopoietic growth factor granulocyte colony-stimulating factor (G-CSF) has a role in proliferation, differentiation and migration of the myeloid lineage and in mobilizing hematopoietic stem and progenitor cells into the bloodstream. However, G-CSF has been newly characterized as a neurotrophic factor in the brain. We recently uncovered that autonomic nerve development in the tumor microenvironment participates actively in prostate tumorigenesis and metastasis. Here, we found that G-CSF constrains cancer to grow and progress by, respectively, supporting the survival of sympathetic nerve fibers in 6-hydroxydopamine-sympathectomized mice and also, promoting the aberrant outgrowth of parasympathetic nerves in transgenic or xenogeneic prostate tumor models. This provides insight into how neurotrophic growth factors may control tumor neurogenesis and may lead to new antineurogenic therapies for prostate cancer.
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Affiliation(s)
- Kostantin Dobrenis
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY
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12
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Pharmacoeconomics of granulocyte colony-stimulating factor: a critical review. Adv Ther 2014; 31:683-95. [PMID: 24989316 DOI: 10.1007/s12325-014-0133-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In the USA, neutropenia-related hospitalization is estimated to occur in 34.2 cases per 1,000 chemotherapy-treated patients. The cost of hospitalization is significant with estimates ranging, on average, from $10,000 to $30,000 per neutropenia-related hospitalization. Prophylactic use of granulocyte colony-stimulating factor (G-CSF) significantly reduces the risk and duration of neutropenia-related negative events. However, the exact economic benefits of using G-CSF prophylactically are not completely known. The objective of this review is to examine the cost of G-CSF as primary prophylaxis (PP) as well as when used reactively to treat severe neutropenia (SN) or febrile neutropenia (FN). METHODS Electronic databases were searched for studies published up to January 2014. RESULTS The evidence supporting the cost-effectiveness of PP use of G-CSF is inconsistent. The cost savings of PP use of G-CSF associated with the reduction of neutropenia-related events are offset by the increased costs associated with improved chemotherapy administration. Cost savings due to the reduction in mortality and disease/symptoms and use of dose-dense regimens have not been adequately incorporated into previous cost-effectiveness studies. Available data suggest that using G-CSF in conjunction with antibiotics is more cost-effective than antibiotics alone when treating patients with SN/FN. Recent studies of biosimilars suggest that they are as effective as originator G-CSFs and, given their lower cost, could represent a cost-effective alternative. Finally, studies have not taken into consideration the indirect patient costs of experiencing a neutropenia-related event. CONCLUSION G-CSF use is effective in preventing SN/FN. Costs due to hospitalization and other neutropenia-related events are lower in patients treated with G-CSF as PP versus untreated patients. Despite this, many studies have not found solid evidence for the overall cost-effectiveness of PP use of G-CSF. One possibility for this is that patients receiving G-CSF prophylactically often receive more intense chemotherapy regimens, have better relative dose intensity, and fewer dose delays, and thereby have greater costs associated with chemotherapy administration than patients who do not receive G-CSF.
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Takahashi H, Kato M, Kikuchi A, Hanada R, Koh K. Delayed short-term administration of granulocyte colony-stimulating factor is a good mobilization strategy for harvesting autologous peripheral blood stem cells in pediatric patients with solid tumors. Pediatr Transplant 2013; 17:688-93. [PMID: 23962050 DOI: 10.1111/petr.12137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/30/2022]
Abstract
PBSCs have become the preferred source of autologous stem cells for supporting high-dose chemotherapy in childhood solid tumors. The aims of this retrospective study were to examine the optimal timing for administration of G-CSF after chemotherapy and to identify the patients from whom an optimal dose of PBSCs can be harvested. We evaluated the timing of G-CSF administration for harvesting PBSCs in patients with childhood solid tumors. G-CSF was administered immediately after chemotherapy in eight patients (11 harvests, long-term group) and following recovery from hematological nadirs in 17 patients (21 harvests, short-term group). The median duration of G-CSF administration was 22 vs. 5 days, respectively (p < 0.005), and the dose of harvested CD34(+) cells (×10(6) /kg) was 1.4 vs. 2.9, respectively (p = 0.023). Our results suggest that short-term G-CSF administration is a good strategy for harvesting PBSCs in these patients.
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Affiliation(s)
- Hiroyoshi Takahashi
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
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Effect of primary prophylactic granulocyte-colony stimulating factor use on incidence of neutropenia hospitalizations for elderly early-stage breast cancer patients receiving chemotherapy. Med Care 2011; 49:649-57. [PMID: 21478779 DOI: 10.1097/mlr.0b013e318215c42e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Chemotherapy is vital for breast cancer management, but early-onset toxicities like neutropenia hinder its administration, especially in the elderly. Primary prophylactic (PP) use of granulocyte-colony stimulating factors (G-CSF) helps prevent neutropenia and its complications while receiving chemotherapy. Nevertheless, evidence supporting the effectiveness of PPG-CSF in the elderly is limited. Thus, the American Society of Clinical Oncology (ASCO) guidelines for PPG-CSF use in the elderly are not explicit. This study analyzed the effects of administration of PPG-CSF and duration of administration on the occurrence of chemotherapy-induced neutropenia hospitalizations in elderly breast cancer patients. METHODS This retrospective observational study of newly diagnosed breast cancer patients receiving chemotherapy used Surveillance, Epidemiology, and End Results-Medicare data from 1994 to 2003. To account for the nonrandom nature of the observational data, a nonparametric matching technique was used to preprocess the data before parametrically estimating the treatment effects. RESULTS Administration of PPG-CSF during the first course chemotherapy reduced neutropenia hospitalizations by 16% within the first 3 months and 17% within the first 6 months of chemotherapy initiation (P < 0.05). Hospitalization rates within the first 3 months of chemotherapy initiation were 3 times higher in women receiving less than 5 consecutive days of PPG-CSF compared with women receiving PPG-CSF for 5 or more days (P < 0.05). Hospitalization rates within the first 1 and 6 months were also lower with longer PPG-CSF duration (≥5 d) (P < 0.10). CONCLUSIONS PPG-CSF use is associated with reductions in in-patient healthcare utilization. These findings have implications for ASCO guidelines and Medicare coverage policies for PPG-CSF administration in elderly breast cancer patients.
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Gascón P, Aapro M, Ludwig H, Rosencher N, Turner M, Song M, MacDonald K, Lee C, Muenzberg M, Abraham I. Background and methodology of MONITOR-GCSF, a pharmaco-epidemiological study of the multi-level determinants, predictors, and clinical outcomes of febrile neutropenia prophylaxis with biosimilar granulocyte-colony stimulating factor filgrastim. Crit Rev Oncol Hematol 2011; 77:184-97. [DOI: 10.1016/j.critrevonc.2010.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 01/27/2010] [Indexed: 11/26/2022] Open
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Chemotherapy characteristics are important predictors of primary prophylactic CSF administration in older patients with breast cancer. Breast Cancer Res Treat 2010; 127:511-20. [DOI: 10.1007/s10549-010-1216-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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Abstract
Chemotherapy-induced febrile neutropenia is costly in both financial and human terms. The associated costs can be reduced substantially through the development and implementation of national policies and locally agreed protocols for the prevention and management of febrile neutropenia. Patients, the NHS, healthcare professionals and the broader community all stand to benefit from a commitment to effective management of this common and predictable side effect of some chemotherapy regimens for early-stage breast cancer.
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Wingard JR, Elmongy M. Strategies for minimizing complications of neutropenia: Prophylactic myeloid growth factors or antibiotics. Crit Rev Oncol Hematol 2009; 72:144-54. [PMID: 19237297 DOI: 10.1016/j.critrevonc.2009.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 01/05/2009] [Accepted: 01/15/2009] [Indexed: 11/29/2022] Open
Affiliation(s)
- John R Wingard
- Division of Hematology/Oncology, University of Florida College of Medicine, P.O. Box 103633, 1376 Mowry Road, Gainesville, FL 32610-3633, USA.
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Aapro M, Schwenkglenks M, Lyman GH, Lopez Pousa A, Lawrinson S, Skacel T, Bacon P, von Minckwitz G. Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy. Crit Rev Oncol Hematol 2009; 74:203-10. [PMID: 19748281 DOI: 10.1016/j.critrevonc.2009.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 06/17/2009] [Accepted: 06/18/2009] [Indexed: 01/21/2023] Open
Abstract
We investigated the incidences of febrile neutropenia (FN) and related complications in elderly (> or =65 years) breast cancer patients receiving chemotherapy supported by pegfilgrastim primary prophylaxis (PP; n=150) or current practice (CP) neutropenia management (n=104) in a subanalysis of NeuCuP (Neulasta) vs. current practice neutropenia management). Studies involving regimens with moderately high to high (> or =15%) FN risk were identified by literature review, and individual patient data were integrated for analysis. FN incidence was 6% (95% CI: 2, 10%) in the PP group and 24% (95% CI: 16, 32%) in the CP group. In cycle 1, incidences were 3 and 15%, respectively. FN-related hospitalisation incidence was 5% (PP group) and 15% (CP group), while dose reductions (>/=15%) occurred in 15 and 29% of patients. Pegfilgrastim provided effective PP in elderly patients, a population who may be vulnerable to chemotherapy-related FN and for whom current practice may not provide adequate protection.
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Affiliation(s)
- Matti Aapro
- Institut Multidisciplinaire d'Oncologie (IMO), Clinique de Genolier, 1 Route du Muids, 1272 Genolier, Switzerland.
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Pharmacologic rationale for early G-CSF prophylaxis in cancer patients and role of pharmacogenetics in treatment optimization. Crit Rev Oncol Hematol 2008; 72:21-44. [PMID: 19111474 DOI: 10.1016/j.critrevonc.2008.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 10/14/2008] [Accepted: 10/22/2008] [Indexed: 11/22/2022] Open
Abstract
The use of recombinant human granulocyte colony stimulating factors (G-CSF) has become an integral part of supportive care during cytotoxic chemotherapy. Current guidelines recommend the use of G-CSF in patients with substantial risk of febrile neutropenia. However, little consensus exists about optimal timing and tailoring of this therapy. Based on the known effects of chemotherapy and G-CSF on bone marrow compartments, we propose a model that supports the prophylactic rather than therapeutic use of G-CSF therapy. In addition, several genetic alterations in G-CSF signalling pathway have been described. These genetic variants may predict the risk of febrile neutropenia and response to G-CSF. Thus, future pharmacogenetic/omics studies in this field are warranted. Through the identification of patients at risk and the knowledge of biological basis for optimal timing, hopefully we should soon be able to improve the application of the existing guidelines for G-CSF therapy and patient's prognosis.
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