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Hobbs J, Lowe J, Ferdinand A, Shook A, Beck B, Blais D, Borchardt C, Xu B. Efficacy of same-day versus next-day administration of pegfilgrastim for the prevention of chemotherapy-induced febrile neutropenia in breast cancer patients receiving dose-dense doxorubicin and cyclophosphamide: A retrospective multi-site analysis. J Oncol Pharm Pract 2023; 29:1853-1861. [PMID: 36579812 DOI: 10.1177/10781552221148116] [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] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Administering pegfilgrastim on the same day as chemotherapy can improve patient satisfaction through convenience and may increase the utilization of cost-effective biosimilars compared to next-day administration, but the effect on clinical outcomes with commonly used breast cancer regimens is unclear. METHODS This multi-site, retrospective cohort study included breast cancer patients age 18 years or older who received dose-dense doxorubicin and cyclophosphamide (ddAC) and pegfilgrastim between 1 June 2016 and 31 May 2020. Pegfilgrastim was given on the same day as chemotherapy at one site and the day after chemotherapy at the other two sites. The primary endpoint compared the incidence of febrile neutropenia associated with pegfilgrastim administration timing. RESULTS A total of 360 patients were reviewed (146 same-day administration and 214 next-day administration). In the same-day group 36 patients (24.6%) developed FN compared to 25 patients (11.7%) in the next-day group (p = 0.002). Same-day administration also significantly increased the incidences of additional acute care visits (11.6% vs 2.8%, p = 0.0016), grade ≥ 3 neutropenia (38.4% vs 13.6%, p < 0.0001), chemotherapy dose reductions (21.2% vs 6.1%, p < 0.0001), and antibiotic use (26.7% vs 12.6%, p = 0.001). Same-day administration did not significantly increase the rate of hospitalization (15% vs 11.2%, p = 0.36) and delay of next chemotherapy cycle by ≥1 day (8.2% vs 6.1%, p = 0.57) due to neutropenic complications. CONCLUSIONS Administering pegfilgrastim on the same day as ddAC led to a significant increase in neutropenic complications. This study confirms the need to administer pegfilgrastim the day after chemotherapy in breast cancer patients receiving ddAC.
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Affiliation(s)
- Jacob Hobbs
- Department of Pharmacy, Avera Cancer Institute at Sioux Falls, Sioux Falls, South Dakota, USA
| | - Jan Lowe
- John T. Vucurevich Cancer Care Institute Pharmacy, Monument Health, Rapid City, South Dakota, USA
| | - Abigale Ferdinand
- John T. Vucurevich Cancer Care Institute Pharmacy, Monument Health, Rapid City, South Dakota, USA
| | - Anna Shook
- Cancer Center Pharmacy, MercyOne North Iowa, Mason City, Iowa, USA
| | - Bradley Beck
- Department of Pharmacy, Avera Cancer Institute at Sioux Falls, Sioux Falls, South Dakota, USA
| | - Danielle Blais
- Department of Pharmacy, Avera Cancer Institute at Sioux Falls, Sioux Falls, South Dakota, USA
| | - Cole Borchardt
- Department of Pharmacy, Avera Cancer Institute at Sioux Falls, Sioux Falls, South Dakota, USA
| | - Bing Xu
- Molecular and Experimental Medicine, Avera Cancer Institute at Sioux Falls, Sioux Falls, South Dakota, USA
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Patel A, Pathak A, Sarin A, Shelly D, Ranjan R, Singh A, Kala T, PV B. Phase 1/2 Study of the Timing and Efficacy of 3 mg Peg-GCSF in Neo/Adjuvant Dose Dense Breast Cancer Treatment Protocols. South Asian J Cancer 2023; 12:238-244. [PMID: 38047054 PMCID: PMC10691905 DOI: 10.1055/s-0042-1757599] [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] [Indexed: 12/05/2023] Open
Abstract
Amol PatelBackground Peg-GCSF has similar efficacy at a dose of 60 µg/kg and 100 µg/kg. The conventional 6 mg SC dose was based on the maximum tolerable dose. In Japan, 3.6 mg dose was approved on the basis of dose finding studies. Peg-GCSF is an integral part of dose-dense chemotherapy protocols. Dose finding and scheduling study of peg-GCSF have not been conducted in Indian patients. Materials and Methods We conducted two-center phase 1/2 clinical study addressing the timing and efficacy of peg-GCSF in Indian breast cancer patients (CTRI no: 2021/07/034751). Three groups of timing administration were studied, namely 1, 6, and 24 hours post chemotherapy. The phase 2 part was the expansion of the best timing group. The primary objective was dose density, which was defined as receiving chemotherapy on < 3 days of scheduled date. Adriamycin/epirubicin cyclophosphamide (AC/EC) was administered q2 weeks. The total leucocyte (TLC) and absolute neutrophil (ANC) kinetics were studied. Other outcomes were incidence of grade 4 neutropenia, febrile neutropenia (FN), and requirement of additional doses of G-CSF. Bone pain, fever, and myalgia were studied for adverse effects. Results From November 20 to December 21, 36 patients were enrolled. Patient characteristics are depicted in Table 1. Initially, three patients received the peg-GCSF in each timing group. One patient in each 1-hour and 6 hours needed G-CSF support for maintaining the dose density. The 24-hour group was carried to phase 2 part. Dose density was maintained in 97% of patients. None of the patient in 24-hour group had FN. Also, 4/30 patients had grade 4 neutropenia and required an additional dose of GCSF. Grade 3 or 4 bone pain was not noticed by any of the patients. During the first cycle, the mean ANC (cells/μL) was 5284, 20704, 3010, 6954 on D0, D + 3, D + 7, and D + 13, respectively (Fig. 1A-TLC and 1B-ANC). The mean ANC (cells/μL) rise on D + 3 in cycles 1, 2, 3, 4 was 23810, 29209, 32428,22455, respectively. Conclusion Dose density of AC/EC breast cancer protocol is maintained with peg-GCSF 3 mg. Post chemotherapy 24-hour timing of peg-GCSF administration remains as the standard. A phase 3 trial of 6 mg versus 3 mg is warranted.
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Affiliation(s)
- Amol Patel
- Indian Naval Hospital Ship, Asvini, Mumbai, Maharashtra, India
| | | | - Arti Sarin
- Western Naval Command, Mumbai, Maharashtra, India
| | - Divya Shelly
- Indian Naval Hospital Ship, Asvini, Mumbai, Maharashtra, India
| | | | - Arashdeep Singh
- Indian Naval Hospital Ship, Asvini, Mumbai, Maharashtra, India
| | - Tripti Kala
- Day Care Chemotherapy Centre, INHS, Asvini, Mumbai, Maharashtra, India
| | - Babitha PV
- Day Care Chemotherapy Centre, INHS, Asvini, Mumbai, Maharashtra, India
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Humphreys SZ, Geller RB, Walden P. Pegfilgrastim Biosimilars in US Supportive Oncology: A Narrative Review of Administration Options and Economic Considerations to Maximize Patient Benefit. Oncol Ther 2022; 10:351-361. [PMID: 36114331 PMCID: PMC9483396 DOI: 10.1007/s40487-022-00207-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) biologics, such as pegfilgrastim, are a standard of care in supportive cancer treatment that are administered once per chemotherapy cycle to reduce the incidence of febrile neutropenia. The high cost of these biologics in the United States can be a limiting factor to accessing care; however, lower-cost pegfilgrastim biosimilars have been available for several years for patients requiring prophylaxis of febrile neutropenia. Different options for pegfilgrastim administration are also now available to accommodate specific patient preferences. As patients may want to minimize the risk of both neutropenia and SARS-CoV-2 infection, same-day administration is a pertinent option during the present COVID-19 pandemic. Therefore, individualized, patient-centered approaches and risk-management strategies should be considered when selecting the treatment and administration method for prophylaxis of febrile neutropenia. Three methods of administration would minimize hospital or clinic visits while also providing the prophylactic effect of G-CSF: same-day administration after chemotherapy, use of the US Food and Drug Administration–approved on-body injector delivering pegfilgrastim approximately 27 h after chemotherapy, or self-administration by the patient or caregiver > 24 h after chemotherapy. Choice of the specific administration option should be based on the patient’s specific needs, while also considering mitigating factors, such as the economic burden associated with biologic medications and the risk of COVID-19. Pegfilgrastim biosimilars can minimize the additional financial burden on patients and the health care system during this pandemic and beyond.
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Rifkin RM, Crawford J, Mahtani RL, Dale DC, Narang M, MacLaughlin WW, Huynh C, Gawade PL, Lewis S, DeCosta L, Lawrence T, Belani R. A prospective study to evaluate febrile neutropenia incidence in patients receiving pegfilgrastim on-body injector vs other choices. Support Care Cancer 2022; 30:7913-7922. [PMID: 35732748 PMCID: PMC9216302 DOI: 10.1007/s00520-022-07226-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Purpose We evaluated the incidence of febrile neutropenia (FN) and related clinical outcomes among patients treated with myelosuppressive chemotherapy for nonmyeloid malignancies who received pegfilgrastim on-body injector (OBI) or other options (Other) for FN prophylaxis. Methods In this prospective observational study, adult patients with breast, prostate, or lung cancer, or non-Hodgkin lymphoma at risk for FN were stratified into subgroups based on FN prophylaxis used in the first chemotherapy cycle: pegfilgrastim OBI vs Other (pegfilgrastim or biosimilar pegfilgrastim prefilled syringe, daily filgrastim, or no granulocyte colony–stimulating factor [G-CSF]) for up to 4 planned chemotherapy cycles. Results This US study enrolled 2575 eligible patients (OBI, 1624; Other, 951). FN incidence was lower in the OBI group (6.4% [95% CI, 5.2–7.6%]) than in the Other group (9.4% [7.5–11.2%]), with a relative risk (RR) of 0.66 (0.47–0.91; p = .006). A decreased risk of dose delays among patients receiving pegfilgrastim OBI vs Other was observed (RR for ≥ 5 days: 0.64 [0.42–0.96], p = .023; RR for ≥ 7 days: 0.62 [0.40–0.91], p = .016). Adherence, defined as G-CSF support for all chemotherapy cycles, was 94.0% (92.9–95.2%) in the OBI group compared with 58.4% (55.2–61.5%) in the Other group. Compliance with pegfilgrastim, defined as administration the day after chemotherapy, was 88.3% in the OBI group and 48.8% in the prefilled syringe group. Conclusion Patients receiving pegfilgrastim OBI had a lower incidence of FN compared with those receiving alternatives. The OBI was associated with improved adherence to and compliance with clinically recommended G-CSF prophylaxis. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07226-9.
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Affiliation(s)
- Robert M Rifkin
- US Oncology Hematology Research, Rocky Mountain Cancer Centers - Midtown, 1800 Williams Street, Suite 200, Denver, CO, 80218, USA.
| | | | - Reshma L Mahtani
- Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, Deerfield Beach, FL, USA
| | - David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Mohit Narang
- US Oncology Research, Maryland Oncology Hematology, P.A, Columbia, MD, USA
| | | | - Chanh Huynh
- Cancer Care Associates of York, York, PA, USA
| | | | | | - Lucy DeCosta
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
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Kitchen K, Mosier MC. Real-world febrile neutropenia rates with same-day versus next-day pegfilgrastim after myelosuppressive chemotherapy. Future Oncol 2022; 18:2551-2560. [PMID: 35708316 DOI: 10.2217/fon-2022-0365] [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: 11/21/2022] Open
Abstract
Aim: To compare the incidence of febrile neutropenia (FN) after same-day versus next-day pegfilgrastim. Materials & methods: This single-institution, real-world, retrospective electronic health record-based study included patients who received chemotherapy and prophylactic same-day or next-day pegfilgrastim/pegfilgrastim-cbqv. Results: In cycle 1, 117 patients received same-day pegfilgrastim and 180 patients received next-day pegfilgrastim. FN episodes in cycle 1 occurred in 6.0 versus 6.7% of patients with same-day versus next-day pegfilgrastim, respectively (p = 0.814). Across all cycles, 8.5 and 9.4% of patients experienced ≥1 FN episode after same-day versus next-day pegfilgrastim, respectively (p = 0.793). In the breast cancer patient subgroup, FN occurred 3.2% of same-day pegfilgrastim cycles versus 1.8% of next-day pegfilgrastim cycles (p = 0.938). Conclusion: No significant differences were detected between same-day and next-day pegfilgrastim administration.
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Affiliation(s)
- Kyle Kitchen
- Clinical Services Department, Utah Cancer Specialists, Salt Lake City, UT 84124, USA
| | - Michael C Mosier
- Biostatistics Department, EMB Statistical Solutions, LLC, Overland Park, KS 66210, USA
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Alrawashdh N, Vraney J, Choi BM, Almutairi AR, Abraham I, McBride A. Retrospective evaluation of safety and effectiveness of same-day pegfilgrastim in patients with lung cancer. Future Oncol 2022; 18:2381-2390. [PMID: 35477322 DOI: 10.2217/fon-2022-0166] [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] [Indexed: 12/22/2022] Open
Abstract
Aim: To determine the incidence of chemotherapy-induced febrile neutropenia (FN) and related outcomes after same-day pegfilgrastim in lung cancer. Materials & methods: This single-center, retrospective study evaluated electronic health records of patients with lung cancer treated between 2013-2018. The main end points were incidence of FN and grade 3/4 neutropenia after the first and across all chemotherapy cycles. Results: A total of 114 patients received same-day pegfilgrastim in 384 cycles. The incidence of FN and grade 3/4 neutropenia was 2.3 and 25% after the first chemotherapy cycle and 1.6 and 10.4% across all cycles, respectively. Conclusion: Same-day prophylactic pegfilgrastim in patients with lung cancer may be a suitable option, owing to its low incidence of FN and related outcomes.
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Affiliation(s)
- Neda Alrawashdh
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.,Department of Health Sciences, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Jamie Vraney
- The University of Arizona College of Pharmacy/Banner, University Medical Center Tucson, Tucson, AZ 85721, USA
| | - Briana M Choi
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA
| | - Abdulaali R Almutairi
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.,Drug Sector, Saudi Food & Drug Authority, Riyadh, 13513-7148, Saudi Arabia
| | - Ivo Abraham
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.,Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,The University of Arizona Cancer Center, Tucson, AZ 85719, USA.,Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ 85724, USA.,Matrix45, Tucson, AZ 85743, USA
| | - Ali McBride
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.,The University of Arizona College of Pharmacy/Banner, University Medical Center Tucson, Tucson, AZ 85721, USA.,Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,The University of Arizona Cancer Center, Tucson, AZ 85719, USA
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McBride A, Alrawashdh N, Bartels T, Moore L, Persky D, Abraham I. Same-day versus next-day pegfilgrastim or pegfilgrastim-cbqv in patients with lymphoma receiving CHOP-like chemotherapy. Future Oncol 2021; 17:3485-3497. [PMID: 34241542 DOI: 10.2217/fon-2021-0532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the incidence of febrile neutropenia and related outcomes of prophylactic same-day versus next-day pegfilgrastim/pegfilgrastim-cbqv in patients with lymphoma receiving cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone (CHOP)-like chemotherapy. Methods: Retrospective, real-world, single-institution study. Results: 93 patients received 460 cycles of CHOP-like chemotherapy. The incidence of febrile neutropenia and grade 3/4 chemotherapy-induced neutropenia was 5 and 16.5%, respectively. In 401 cycles pegfilgrastim was administered same-day versus 12 cycles next-day. Febrile neutropenia occurred in 17 cycles versus 0 cycles (p = 1.00) and grade 3/4 chemotherapy-induced neutropenia in 65 cycles (16.2%) versus 1 cycle (16.7%; p = 1.00) with same-day versus next-day pegfilgrastim administration, respectively. Conclusion: Pegfilgrastim may be safely administered on the same day as chemotherapy in patients with lymphoma receiving CHOP-like chemotherapy.
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Affiliation(s)
- Ali McBride
- Banner University Medical Center, Tucson, AZ 85719, USA.,Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.,University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Neda Alrawashdh
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Trace Bartels
- Banner University Medical Center, Tucson, AZ 85719, USA
| | - Logan Moore
- Banner University Medical Center, Tucson, AZ 85719, USA
| | - Daniel Persky
- Banner University Medical Center, Tucson, AZ 85719, USA
| | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.,University of Arizona Cancer Center, Tucson, AZ 85719, USA.,Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ 85724, USA.,Matrix45, Tucson, AZ 85743, USA
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