1
|
Kumar A, Choudhary S, Kumar S, Adhikari JS, Kapoor S, Chaudhury NK. Role of melatonin mediated G-CSF induction in hematopoietic system of gamma-irradiated mice. Life Sci 2022; 289:120190. [PMID: 34883100 DOI: 10.1016/j.lfs.2021.120190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
AIMS Hematopoietic acute radiation syndrome (H-ARS) can cause lethality, and therefore, the necessity of a safe radioprotector. The present study was focused on investigating the role of melatonin in granulocytes colony-stimulating factor (G-CSF) and related mechanisms underlying the reduction of DNA damage in hematopoietic system of irradiated mice. MAIN METHODS C57BL/6 male mice were exposed to 2, 5, and 7.5Gy of whole-body irradiation (WBI), 30 min after intra-peritoneal administration of melatonin with different doses. Mice were sacrificed at different time intervals after WBI, and bone marrow, splenocytes, and peripheral blood lymphocytes were isolated for studying various parameters including micronuclei (MN), cell cycle, comet, γ-H2AX, gene expression, amino acid profiling, and hematology. KEY FINDINGS Melatonin100mg/kg ameliorated radiation (7.5Gy and 5Gy) induced MN frequency and cell death in bone marrow without mortality. At 24 h of post-WBI (2Gy), the frequency of micronucleated polychromatic erythrocytes (mnPCE) with different melatonin doses revealed 20 mg/kg as optimal i.p. dose for protecting the hematopoietic system against radiation injury. In comet assay, a significant reduction in radiation-induced % DNA tail (p ≤ 0.05) was observed at this dose. Melatonin reduced γ-H2AX foci/cell and eventually reached to the control level. Melatonin also decreased blood arginine levels in mice after 24 h of WBI. The gene expression of G-CSF, Bcl-2-associated X protein (BAX), and Bcl2 indicated the role of melatonin in G-CSF regulation and downstream pro-survival pathways along with anti-apoptotic activity. SIGNIFICANCE The results revealed that melatonin recovers the hematopoietic system of irradiated mice by inducing G-CSF mediated radioprotection.
Collapse
Affiliation(s)
- Arun Kumar
- Division of Radiation Biodosimetry, Institute of Nuclear Medicine and Allied Sciences (INMAS)-Defence Research and Development Organisation (DRDO), Brig. SK Mazumdar Marg, Timarpur, Delhi 110054, India
| | - Sandeep Choudhary
- Division of Radiation Biodosimetry, Institute of Nuclear Medicine and Allied Sciences (INMAS)-Defence Research and Development Organisation (DRDO), Brig. SK Mazumdar Marg, Timarpur, Delhi 110054, India; Department of Pharmacology, School of Pharmaceutical Education and Research, Hamdard University, Hamdard nagar, New Delhi 110062, India
| | - Somesh Kumar
- Pediatrics Genetics & Research Laboratory, Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital, Delhi 110002, India
| | - Jawahar S Adhikari
- Division of Radiation Biodosimetry, Institute of Nuclear Medicine and Allied Sciences (INMAS)-Defence Research and Development Organisation (DRDO), Brig. SK Mazumdar Marg, Timarpur, Delhi 110054, India
| | - Seema Kapoor
- Pediatrics Genetics & Research Laboratory, Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital, Delhi 110002, India
| | - Nabo K Chaudhury
- Division of Radiation Biodosimetry, Institute of Nuclear Medicine and Allied Sciences (INMAS)-Defence Research and Development Organisation (DRDO), Brig. SK Mazumdar Marg, Timarpur, Delhi 110054, India.
| |
Collapse
|
2
|
Ku M, Je NK. Underutilisation of prophylactic G-CSF in breast cancer patients receiving adjuvant docetaxel/cyclophosphamide chemotherapy. J Chemother 2021; 34:534-542. [PMID: 34870568 DOI: 10.1080/1120009x.2021.2009988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Docetaxel/cyclophosphamide (TC) is a widely used adjuvant chemotherapy regimen, especially in patients with node-negative or low-risk node-positive breast cancer. Guidelines recommend the use of prophylactic granulocyte colony-stimulating factor (G-CSF) to prevent febrile neutropenia. In this study, we aimed to explore the use of G-CSF as a primary prophylactic and determine the factors influencing its use. This retrospective study used nationwide claims data from the National Inpatient Sample compiled by the Health Insurance Review and Assessment Service in South Korea from 2018. The claims data included 10% of inpatients admitted at least once in 2018 and 1% of outpatients who were not admitted. Female patients with breast cancer who received an adjuvant TC regimen after surgery were selected. Primary prophylactic G-CSF was defined as G-CSF prescribed within two days of the first cycle of TC. The factors influencing its utilisation were investigated using the chi-square test and a multiple logistic regression model. A total of 229 patients were included in the analysis. The proportion of patients who received primary prophylactic G-CSF treatment after the first cycle of TC was 55.5%. The factors positively influencing G-CSF utilization were patients' age ≥65 years, location (i.e. metropolitan areas), and the type of healthcare facility (i.e. non-tertiary hospitals). The use of prophylactic G-CSF in patients with breast cancer who received the adjuvant TC regimen was insufficient. The use of primary G-CSF prophylaxis should be emphasised to reduce the risk of febrile neutropenia among patients receiving a myelosuppressive TC regimen.
Collapse
Affiliation(s)
- Minhee Ku
- College of Pharmacy, Pusan National University, Busan, Republic of Korea.,Department of Pharmacy, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea
| | - Nam Kyung Je
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
| |
Collapse
|
3
|
Maluf FC, de Oliveira FAM, Liedke PER, Brust L, Inocêncio CG, Monteiro FSM, Smaletz O, Cubero DI. Neutropenia Prevention in the Treatment of Post-docetaxel Metastatic, Castration-resistant Prostate Cancer With Cabazitaxel and Prednisone: A Multicenter, Open-label, Single-arm Phase IV Study. Clin Genitourin Cancer 2021; 19:e171-e177. [PMID: 33610484 DOI: 10.1016/j.clgc.2020.12.008] [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: 07/07/2020] [Revised: 11/24/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Severe neutropenia is a dose-limiting factor that occurs in up to 82% of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with cabazitaxel. This study evaluated the effectiveness of granulocyte colony-stimulating factor (G-CSF) plus ciprofloxacin as prophylaxis in post-docetaxel patients with mCRPC treated with cabazitaxel and at high risk for neutropenia. PATIENTS AND METHODS This was a phase IV, multicenter, open-label, single-arm interventional study with men aged ≥ 65 years (or < 65 years and ≥ 25% irradiated bone marrow), presenting with mCRPC after docetaxel failure, performance status ≤ 1, and life expectancy > 12 weeks. Cabazitaxel 25 mg/m2 and prednisone were given on day 1, every 21 days. G-CSF was administered on days 2 to 8 of each cycle or until an absolute neutrophil count > 2000/mm3, and ciprofloxacin 1000 mg was given orally on days 5 to 12. The rate of neutropenia grade ≥ 3 during the first cycle (primary endpoint), and frequency of neutropenia grade ≥ 3, febrile neutropenia, diarrhea grade ≥ 3, prostate-specific antigen response, and quality of life during treatment (secondary end points) were estimated. RESULTS We included 46 patients. The mean number of cabazitaxel cycles was 9.5. During the first cycle, 40.0% of patients had neutropenia grade ≥ 3, and 42.2% had at least 1 episode of neutropenia during treatment. Febrile neutropenia and diarrhea grade ≥ 3 occurred in 1 patient each. Twenty-nine (64.4%) patients achieved prostate-specific antigen response, and 77.2% improved quality of life scores in at least 1 visit. CONCLUSIONS Prophylactic G-CSF was effective in preventing neutropenia grade ≥ 3 and other hematologic complications during treatment with cabazitaxel 25 mg/m2 in post-docetaxel patients with mCRPC at high risk for neutropenia. The role of prophyclatic ciprofloxacin to prevent febrile neutropenia in this setting is still unclear and needs to be further evaluated.
Collapse
Affiliation(s)
- Fernando C Maluf
- Clinical Oncology Department, "Beneficência Portuguesa de São Paulo" Hospital, São Paulo, Brazil; Albert Einstein Hospital, São Paulo, Brazil.
| | | | - Pedro E R Liedke
- Clinical Oncology Department/ Clinical Oncology Research Unit (UPCO), Clinic Hospital of Porto Alegre, Porto Alegre, Brazil; Cancer Hospital "Mãe de Deus", Porto Alegre, Brazil
| | - Leandro Brust
- Oncology Department, Bruno Born Hospital, Lajeado, Brazil
| | - Cristina G Inocêncio
- Oncology and Hematology "Dr Ademar Lopes" Search Center, Cuiabá, Brazil; Oncomed - Multidisciplinary Treatment of Cancer Clinic, Cuiabá, Brazil
| | | | | | - Daniel I Cubero
- CEPHO - Center for Studies and Research in Hematology and Oncology, Medicine Faculty of ABC, Santo André, Brazil
| |
Collapse
|
4
|
Liu M, Han S, Zheng B, Cai H, Yang J, Zhuang Q, Li N. Cost-Effectiveness Analysis Of Pembrolizumab In The Treatment Of Advanced Recurrent Metastatic Head And Neck Squamous Cell Carcinoma In China And The United States. Cancer Manag Res 2019; 11:9483-9493. [PMID: 31814756 PMCID: PMC6858623 DOI: 10.2147/cmar.s226243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pembrolizumab, a programmed cell death-1 (PD-1) inhibitor, has recently gained prominence as a second-line treatment for recurrent and/or metastatic head and neck squamous cell cancer (R/M HNSCC). This study compares the acceptance and different influencing factors of pembrolizumab in the treatment of R/M HNSCC in developed (i.e., the United States) and developing (i.e., China) countries through cost-effectiveness analysis and provides valuable suggestions for clinical decision making. METHODS A Markov model was constructed using TreeAge Pro 2015 software to evaluate the economic value of four treatment strategies. Quality-adjusted life years (QALY) and incremental cost-effectiveness ratio (ICER) were used as economic indicators for incremental cost-effectiveness analysis. The stability of the model was evaluated by one-way sensitivity and probability sensitivity analyses. RESULTS The ICERs for the pembrolizumab group versus PD-L1 CPS treatment in China and the US were $7892/QALY and $11,900/QALY, respectively. All ICERs were less than the threshold of $29,306 in China and $50,000 in the US; thus, pembrolizumab is cost effective. Sensitivity analysis confirmed a stable economic advantage in the single-drug regimen of pembrolizumab in China and the US. CONCLUSION Pembrolizumab monotherapy as a second-line treatment for R/M HNSCC presents more health benefits in comparison with the standard, PD-L1 TPS and PD-L1 CPS groups in China and the US.
Collapse
Affiliation(s)
- Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- The School of Pharmacy, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Sijie Han
- The School of Pharmacy, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- The School of Pharmacy, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Hongfu Cai
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- The School of Pharmacy, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- The School of Pharmacy, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Qian Zhuang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- The School of Pharmacy, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China
- The School of Pharmacy, Fujian Medical University, Fuzhou, People’s Republic of China
| |
Collapse
|
5
|
Gao L, Li SC. Cost-effectiveness analysis of lipegfilgrastim as primary prophylaxis in women with breast cancer in Australia: a modelled economic evaluation. Breast Cancer 2018; 25:671-680. [PMID: 29802592 DOI: 10.1007/s12282-018-0872-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/19/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine the cost-effectiveness of lipegfilgrastim versus pegfilgrastim as primary prophylaxis in women with early stage breast cancer. METHODS Two Markov models including a chemotherapy and a post-chemotherapy models were constructed with a time horizon of 12 weeks and 30 years, respectively. All the transition probabilities and utility weights were derived from clinical trials and/or published literatures. The costs populated in the chemotherapy model were extracted from Medicare, Pharmaceutical Benefit Scheme and the Independent Hospital Pricing Authority. No cost was considered in the post-chemotherapy model. Sensitivity analyses were performed to test the robustness of the results. RESULTS From the first chemotherapy model, lipegfilgrastim was associated with fewer episodes of severe neutropenia (SN) (N = 142 per 1000 patients treated), febrile neutropenia (FN) (N = 29 per 1000 patients treated), infection (N = 17 per 1000 patients treated) and chemotherapy delayed (N = 170 per 1000 patients treated) and lower cost ($116.88 less per patient treated). The post-chemotherapy model indicated lipegfilgrastim led to higher gains in both life years (18.72 versus 18.61) and quality-adjusted life years (17.28 versus 17.18) in comparison to pegfilgrastim. Sensitivity analysis showed that the results from the chemotherapy model is very sensitive to the baseline risk of SN; while from the probabilistic sensitivity analysis, lipegfilgrastim was likely to be more cost-effective than pegfilgrastim based on two models. CONCLUSIONS Lipegfilgrastim was likely to be a cost-effective alternative to pegfilgrastim as primary prophylaxis. The sensitivity analysis showed the confidence interval for the cost and benefit outcomes overlapped to a great extent, suggesting an insignificant difference.
Collapse
Affiliation(s)
- Lan Gao
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia.
| | - Shu-Chuen Li
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
6
|
Hilton J, Mazzarello S, Fergusson D, Joy AA, Robinson A, Arnaout A, Hutton B, Vandermeer L, Clemons M. Novel Methodology for Comparing Standard-of-Care Interventions in Patients With Cancer. J Oncol Pract 2016; 12:e1016-e1024. [DOI: 10.1200/jop.2016.013474] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: The current clinical trials development and conduct process is cumbersome and expensive, with the majority of studies focusing on either the development of new agents or new indications for established agents. Unfortunately, research comparing standard-of-care interventions is rarely performed, leaving many important and practical patient-centered questions unanswered. Novel clinical trial methodologies and approaches are needed. Methods: We have identified simple key components that, when combined, enhance the ability to both perform and increase accrual for studies that compare standard-of-care interventions. These include selection of clinically relevant and practical questions, demonstration of clinical equipoise through surveys of knowledge users and completion of systematic reviews, appropriate study design and simply defined study end points, use of an integrated consent model incorporating oral consent, efficient research ethics board approval, Web-based randomization in the clinic, real-time electronic data capture and management, and regular formal team feedback. Results: We have demonstrated the feasibility of this model in a pragmatic trial comparing two standard-of-care interventions (growth factor support or ciprofloxacin) for the primary prophylaxis of febrile neutropenia in patients with breast cancer receiving adjuvant docetaxel with cyclophosphamide chemotherapy. Research ethics board approval took 3 months, and 110 (72%) of 153 potentially eligible patients have agreed to participate in the study. When surveyed, 81 (85%) of 95 patients were completely satisfied with the integrated consent model process. Conclusion: Our proposed model contains elements that, when used alone or in combination, may allow efficient and cost-effective comparison of standard-of-care interventions.
Collapse
Affiliation(s)
- John Hilton
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Sasha Mazzarello
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Dean Fergusson
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Anil A. Joy
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Andrew Robinson
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Angel Arnaout
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Brian Hutton
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Lisa Vandermeer
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| | - Mark Clemons
- The Ottawa Hospital; University of Ottawa; Ottawa Hospital Research Institute, Ottawa; University of Alberta, Edmonton; and Kingston General Hospital, Kingston, Ontario, Canada
| |
Collapse
|
7
|
Fernandes R, Mazzarello S, Stober C, Vandermeer L, Dudani S, Ibrahim MFK, Majeed H, Perdrizet K, Shorr R, Hutton B, Fergusson D, Clemons M. Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: a systematic review. Breast Cancer Res Treat 2016; 161:1-10. [PMID: 27783280 DOI: 10.1007/s10549-016-4028-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Due to the high rate of febrile neutropenia (FN) with docetaxel-cyclophosphamide (DC) chemotherapy, primary FN prophylaxis is recommended. However, the optimal choice of prophylaxis [i.e., granulocyte-colony stimulating factors (G-CSF) or antibiotics] is unknown. A systematic review was performed to address this knowledge gap. METHODS Embase, Ovid Medline, Pubmed, the Cochrane database of systematic reviews, and Cochrane register of controlled trials were searched from 1946 to April 2016 for studies evaluating primary prophylactic FN treatments in breast cancer patients receiving DC chemotherapy. Outcome measures evaluated included: incidence of FN and treatment-related hospitalizations, chemotherapy dose reduction/delays/discontinuations, and adverse events. Screening and data collection were performed by two independent reviewers. RESULTS Of 2105 identified records, 7 studies (n = 2535) met the pre-specified eligibility criteria. Seven additional studies (n = 621) were identified from prior systematic reviews. There were 3 randomized controlled trials (RCTs) (n = 2256) and 11 retrospective studies (n = 900). Study sample sizes ranged from 30 to 982 patients (median 99.5), evaluating pegfilgrastim (n = 1274), filgrastim (n = 1758), and oral ciprofloxacin (n = 108). Given the heterogeneity of patients and study design, a narrative synthesis of results was performed. Median FN rates with and without primary prophylaxis were 6.6 % (IQR 3.9-10.6 %) and 31.3 % (IQR 25-33 %), respectively. No FN-related deaths were reported. No RCT directly compared G-CSF with antibiotic interventions. CONCLUSIONS Primary FN prophylaxis reduces the incidence of FN. Despite considerable cost and toxicity differences between G-CSF and antibiotics, there is insufficient data to make a recommendation of one strategy over another.
Collapse
Affiliation(s)
- Ricardo Fernandes
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | | | - Carol Stober
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Shaan Dudani
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Mohamed F K Ibrahim
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - Habeeb Majeed
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Kirstin Perdrizet
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | | | - Brian Hutton
- Department of Medicine, Clinical Epidemiology Program, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Dean Fergusson
- Department of Medicine, Clinical Epidemiology Program, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada. .,Ottawa Hospital Research Institute, Ottawa, Canada. .,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
8
|
Younis T, Rayson D, Jovanovic S, Skedgel C. Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review. Breast Cancer Res Treat 2016; 159:425-32. [PMID: 27572552 DOI: 10.1007/s10549-016-3954-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/22/2016] [Indexed: 11/24/2022]
Abstract
The adoption of primary (PP) versus secondary prophylaxis (SP) of febrile neutropenia (FN), with granulocyte colony-stimulating factors (G-CSF), for adjuvant chemotherapy (AC) regimens in breast cancer (BC) could be affected by its "value for money". This systematic review examined (i) cost-effectiveness of PP versus SP, (ii) FN threshold at which PP is cost-effective including the guidelines 20 % threshold and (iii) potential impact of G-CSF efficacy assumptions on outcomes. The systematic review identified all cost-effectiveness/cost-utility analyses (CEA/CUA) involving PP versus SP G-CSF for AC in BC that met predefined inclusion/exclusion criteria. Five relevant CEA/CUA were identified. These CEA/CUA examined different AC regimens (TAC = 2; FEC-D = 1; TC = 2) and G-CSF formulations (filgrastim "F" = 4; pegfilgrastim "P" = 4) with varying baseline FN-risk (range 22-32 %), mortality (range 1.4-6.0 %) and utility (range 0.33-0.47). The potential G-CSF benefit, including FN risk reduction with P versus F, varied among models. Overall, relative to SP, PP was not associated with good value for money, as per commonly utilized CE thresholds, at the baseline FN rates examined, including the consensus 20 % FN threshold, in most of these studies. The value for money associated with PP versus SP was primarily dependent on G-CSF benefit assumptions including reduced FN mortality and improved BC survival. PP G-CSF for FN prevention in BC patients undergoing AC may not be a cost-effective strategy at the guidelines 20 % FN threshold.
Collapse
Affiliation(s)
- T Younis
- Department of Medicine at Dalhousie University and the Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
| | - D Rayson
- Department of Medicine at Dalhousie University and the Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - S Jovanovic
- Department of Medicine at Dalhousie University and the Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - C Skedgel
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|