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Theyab A, Alsharif KF, Alzahrani KJ, Oyouni AAA, Hawsawi YM, Algahtani M, Alghamdi S, Alshammary AF. New insight into strategies used to develop long-acting G-CSF biologics for neutropenia therapy. Front Oncol 2023; 12:1026377. [PMID: 36686781 PMCID: PMC9850083 DOI: 10.3389/fonc.2022.1026377] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/08/2022] [Indexed: 01/07/2023] Open
Abstract
Over the last 20 years, granulocyte colony-stimulating factors (G-CSFs) have become the major therapeutic option for the treatment of patients with neutropenia. Most of the current G-CSFs require daily injections, which are inconvenient and expensive for patients. Increased understanding of G-CSFs' structure, expression, and mechanism of clearance has been very instrumental in the development of new generations of long-acting G-CSFs with improved efficacy. Several approaches to reducing G-CSF clearance via conjugation techniques have been investigated. PEGylation, glycosylation, polysialylation, or conjugation with immunoglobulins or albumins have successfully increased G-CSFs' half-lives. Pegfilgrastim (Neulasta) has been successfully approved and marketed for the treatment of patients with neutropenia. The rapidly expanding market for G-CSFs has increased demand for G-CSF biosimilars. Therefore, the importance of this review is to highlight the principle, elimination's route, half-life, clearance, safety, benefits, and limitations of different strategies and techniques used to increase the half-life of biotherapeutic G-CSFs. Understanding these strategies will allow for a new treatment with more competitive manufacturing and lower unit costs compared with that of Neulasta.
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Affiliation(s)
- Abdulrahman Theyab
- Department of Laboratory and Blood Bank, Security Forces Hospital, Makkah, Saudi Arabia,College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia,*Correspondence: Abdulrahman Theyab, ; Khalaf F. Alsharif,
| | - Khalaf F. Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia,*Correspondence: Abdulrahman Theyab, ; Khalaf F. Alsharif,
| | - Khalid J. Alzahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | | | - Yousef MohammedRabaa Hawsawi
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia,Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammad Algahtani
- Department of Laboratory and Blood Bank, Security Forces Hospital, Makkah, Saudi Arabia
| | - Saad Alghamdi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amal F. Alshammary
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Geßner C, Fietz T, Losem C, Lück A, Schulz H, Niemeier B, Groschek M, Eschenburg H, Weide R, Kretzschmar A, Frost N, Hipp J, Harde J, Matillon CD, Grebhardt S, Potthoff K. Prophylaxis of chemotherapy-induced neutropenia with lipegfilgrastim in patients with lung cancer: final results from the non-interventional study NADIR. Curr Med Res Opin 2022; 38:2191-2199. [PMID: 36047998 DOI: 10.1080/03007995.2022.2113693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Real-world evidence on the application of the granulocyte colony-stimulating factor lipegfilgrastim for the reduction of chemotherapy-induced neutropenia and febrile neutropenia (FN) is limited. The NADIR study aimed to evaluate effectiveness and safety of lipegfilgrastim as primary or secondary prophylaxis in patients with lung cancer undergoing chemotherapy in routine clinical practice. METHODS The non-interventional study NADIR (German Clinical Trials Register (DRKS) Number DRKS00005711) enrolled 156 patients with small-cell lung cancer (SCLC) and 145 patients with non-small-cell lung cancer (NSCLC), who received lipegfilgrastim during chemotherapy. Primary endpoint was the incidence of severe neutropenia (CTCAE grade 3/4) and FN. The analysis was stratified for age groups (≤65 years vs. >65 years). RESULTS Approximately half of the patients were aged >65 years (SCLC 54.5%; NSCLC 46.9%). Intention of antineoplastic treatment was mostly palliative (SCLC 89.1%; NSCLC 73.1%). Patients with high FN risk (SCLC 44.9%; NSCLC 28.3%) mostly received lipegfilgrastim for primary prophylaxis (SCLC 81.4%; NSCLC 70.7%). FN was reported in 1.9% SCLC and 1.4% NSCLC patients. At least one severe neutropenia was documented in 30.1% SCLC and 17.9% NSCLC patients. For NSCLC patients aged >65 years, less severe neutropenia was reported as compared to younger patients (14.7% vs. 20.8%). Lipegfilgrastim-related adverse events were reported in 10.3% SCLC and 7.7% NSCLC patients. CONCLUSION Lipegfilgrastim in routine clinical practice of patients with lung cancer showed similar effectiveness and safety as compared to the pivotal trial. Interestingly, in older patients severe neutropenia was reported less frequently. While most patients with high FN risk received lipegfilgrastim for primary prophylaxis as recommended, there are still 20-30% of patients at high FN risk without primary prophylaxis who could benefit from better adherence to guidelines.
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Affiliation(s)
| | - Thomas Fietz
- Outpatient Center for Hematology, Oncology and Gastroenterology, Singen, Germany
| | - Christoph Losem
- Outpatient Center for Hematology and Oncology, Neuss, Germany
| | - Andreas Lück
- Outpatient Center for Urology and Oncology, Rostock, Germany
| | - Holger Schulz
- Outpatient Center for Internal Oncology and Hematology, Frechen, Germany
| | | | | | - Henning Eschenburg
- Outpatient Center for Internal Medicine, Hematology and Oncology, Güstrow, Germany
| | - Rudolf Weide
- Outpatient Center for Hematology and Oncology, Koblenz, Germany
| | - Albrecht Kretzschmar
- Outpatient Center for Internal Medicine, Hematology and Oncology, Leipzig, Germany
| | - Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin, Berlin, Germany
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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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Ma J, Huang H, Fu P, Xu N, Mao C, Cheng G, Yan H, Li Y, Shi Y, Wang Y, Yao Y, Chen L, Chen Y, Zhang N, Zhang G, Ren Z, Li Z, Song L, Xu R, Qin S. Prophylaxis of neutropenia with mecapegfilgrastim in patients with non-myeloid malignancies: a real-world study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:893. [PMID: 34164527 PMCID: PMC8184427 DOI: 10.21037/atm-21-2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chemotherapy-induced neutropenia is commonly encountered in clinical practice. The management of neutropenia has been evolving from short-acting granulocyte colony-stimulating factors (G-CSFs) to long-acting G-CSFs. However, an evaluation of the safety and effectiveness of long-acting G-CSFs in clinical practice is still lacking. Methods This multicenter, non-interventional study was aimed at exploring the safety and effectiveness of mecapegfilgrastim in different cancer patients in China. All patients provided written informed consent prior to the study and were treated according to routine clinical practice. Different prophylactic strategies (primary or secondary prophylaxis) were also compared. Results This study included 638 patients from May 2019 to November 2020. More than half of the participants were breast cancer patients. The mean age of all the patients was 56 years. White blood cell increase (6.2%) was the most frequently reported adverse event (AE) possibly related to the study drug. No unexpected AEs were reported. Grade ≥3 neutropenia in chemotherapy treatment cycle 1 was reported in 36 (5.6%) patients. Incidence of grade ≥3 neutropenia in cycle 1 in the primary and secondary prophylaxis subgroups were of 4.3% and 9.2%, respectively. A decreasing trend of severe neutropenia incidence was observed from cycle 1 to cycle 4. Conclusions Mecapegfilgrastim was generally well tolerated, and no unexpected AEs were observed in this study. Primary administration of mecapegfilgrastim led to a lower incidence of neutropenia than did secondary administration. Continuous administration of mecapegfilgrastim could keep the incidence of neutropenia to a relatively low level.
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Affiliation(s)
- Jun Ma
- Harbin Institute of Hematology and Oncology, Harbin, China
| | - Huiqiang Huang
- Department of Internal Medicine IV, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Peifen Fu
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Nong Xu
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chenyu Mao
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Cheng
- Department of Oncology, Bozhou People's Hospital, Bozhou, China
| | - Haijiao Yan
- Department of Oncology, The First People's Hospital of Changzhou, Changzhou, China
| | - Yongqing Li
- Department of Breast Surgery II, Shandong Provincial Cancer Hospital, Jinan, China
| | - Yanxia Shi
- Department of Internal Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongsheng Wang
- Department of Breast Surgery I, Shandong Provincial Cancer Hospital, Jinan, China
| | - Yumin Yao
- Department of Breast and Thyroid, Liaocheng People's Hospital, Liaocheng, China
| | - Liang Chen
- Department of gynecology I, Shandong Provincial Cancer Hospital, Jinan, China
| | - Yong Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ningling Zhang
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Guifang Zhang
- Department of Oncology, Xinxiang Central Hospital, Xinxiang, China
| | - Zhangxia Ren
- Department of Burns Plastic Surgery, Breast and Thyroid Surgery, Guang'an People's Hospital, Guang'an, China
| | - Zengjun Li
- Department of Lymphatic Hematology, Shandong Provincial Cancer Hospital, Jinan, China
| | - Lihua Song
- Department of Breast Medicine, Shandong Provincial Cancer Hospital, Jinan, China
| | - Ruihua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shukui Qin
- Qinhuai Medical Area, Eastern Theater General Hospital of PLA China, Nanjing, China
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