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Supportive Care in Cancer
Published in: Supportive Care in Cancer 5/2016

Open Access 01-05-2016 | Original Article

Risk of chemotherapy-induced febrile neutropenia in cancer patients receiving pegfilgrastim prophylaxis: does timing of administration matter?

Authors: Derek Weycker, Xiaoyan Li, Jacqueline Figueredo, Rich Barron, Spiros Tzivelekis, May Hagiwara

Published in: Supportive Care in Cancer | Issue 5/2016

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Abstract

Purpose

Contrary to the approved indication for pegfilgrastim prophylaxis, some patients receive it on the same day as the last administration of chemotherapy in clinical practice, which could adversely impact risk of febrile neutropenia (FN). An evaluation of the timing of pegfilgrastim prophylaxis and FN risk was undertaken.

Methods

A retrospective cohort design and data from two US private health care claims repositories were employed. Study population comprised adults who received intermediate/high-risk chemotherapy regimens for solid tumors or non-Hodgkin’s lymphoma (NHL) and received pegfilgrastim prophylaxis in ≥1 cycle; all cycles with pegfilgrastim were pooled for analyses. Odds ratios (OR) for FN during the cycle were estimated for patients who received pegfilgrastim on the same day (day 1) as the last administration of chemotherapy versus days 2–4 from chemotherapy completion.

Results

The study population included 45,592 patients who received pegfilgrastim in 179,152 cycles (n = 37,095 in cycle 1); in 12 % of cycles, patients received pegfilgrastim on the same day as chemotherapy. Odds of FN were higher for patients receiving pegfilgrastim prophylaxis on the same day as chemotherapy versus days 2–4 from chemotherapy in cycle 1 (OR = 1.6, 95 % CI = 1.3–1.9, p < 0.001) and all cycles (OR = 1.5, 95 % CI = 1.3–1.6, p < 0.001).

Conclusions

In this large-scale evaluation of adults who received intermediate/high-risk regimens for solid tumors or NHL in US clinical practice, FN incidence was found to be significantly higher among those who received pegfilgrastim prophylaxis on the same day as chemotherapy completion versus days 2–4 from chemotherapy completion, underscoring the importance of adhering to the indicated administration schedule.
Appendix
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Literature
1.
Smith TJ, Bohlke K, Lyman GH et al (2015) Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. doi:10.​1200/​JCO.​2015.​62.​3488
2.
Caggiano V, Weiss RV, Rickert TS et al (2005) Incidence, cost and mortality of neutropenia hospitalization associated with chemotherapy. Cancer 103:1916–1924CrossRefPubMed
3.
Lyman GH, Michels SL, Reynolds MW et al (2010) Risk of mortality in patients with cancer who experience febrile neutropenia. Cancer 116:5555–5563CrossRefPubMed
4.
Kuderer NM, Dale DC, Crawford J et al (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106:2258–2266CrossRefPubMed
5.
Bonadonna G, Moliterni A, Zambetti M et al (2005) 30 years’ follow up of randomised studies of adjuvant CMF in operable breast cancer: cohort study. BMJ 330(7485):217CrossRefPubMedPubMedCentral
6.
Lyman GH, Dale DC, Crawford J (2003) Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: a nationwide study of community practices. J Clin Oncol 21:4524–4531CrossRefPubMed
7.
Kwak LW, Halpern J, Olshen RA et al (1990) Prognostic significance of actual dose intensity in diffuse large-cell lymphoma: results of a tree-structured survival analysis. J Clin Oncol 8(6):963–977CrossRefPubMed
8.
9.
Amgen Inc. (2009) Neulasta (pegfilgrastim) prescribing information, Thousand Oaks, CA
10.
Heaney ML, Toy EL, Vekeman F et al (2009) Comparison of hospitalization risk and associated costs among patients receiving sargramostim, filgrastim, and pegfilgrastim for chemotherapy-induced neutropenia. Cancer 115:4839–4848CrossRefPubMed
11.
Weycker D, Malin J, Barron R et al (2011) Comparative effectiveness of filgrastim, pegfilgrastim, and sargramostim as prophylaxis against hospitalization for neutropenic complications in cancer chemotherapy patients. Am J Clin Oncol. doi:10.​1097/​COC.​0b013e31820dc075​
12.
Morrison VA, Wong M, Hershman D et al (2007) Observational study of the prevalence of febrile neutropenia in patients who received filgrastim or pegfilgrastim associated with 3–4 week chemotherapy regimens in community oncology practices. J Manag Care Pharm 13(4):337–348PubMed
13.
Amgen Inc. (2009) Neupogen (filgrastim) prescribing information, Thousand Oaks, CA
14.
Green MD, Koelbl H, Baselga J et al (2003) A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol 14(1):29–35CrossRefPubMed
15.
Holmes FA, O'Shaughnessy JA, Vukelja S et al (2002) Blinded, randomized, multicenter study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in patients with high-risk stage II or stage III/IV breast cancer. J Clin Oncol 20(3):727–731CrossRefPubMed
16.
Vogel CL, Wojtukiewicz MZ, Carroll RR et al (2005) First and subsequent cycle use of pegfilgrastim prevents febrile neutropenia in patients with breast cancer: a multicenter, double-blind, placebo-controlled phase III study. J Clin Oncol 23(6):1178–1184CrossRefPubMed
17.
Trillet-Lenoir V, Green J, Manegold C et al (1993) Recombinant granulocyte colony stimulating factor reduces the infectious complications of cytotoxic chemotherapy. Eur J Cancer 29A:319–324CrossRefPubMed
18.
Crawford J, Ozer H, Stoller R et al (1991) Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. NEJM 325:164–170CrossRefPubMed
19.
Weycker D, Edelsberg J, Kartashov A et al (2012) Risk and healthcare costs of chemotherapy-induced neutropenic complications in women with metastatic breast cancer. Chemotherapy 58:8–18CrossRefPubMed
20.
Schuman S, Lambrou N, Robson K et al (2009) Pegfilgrastim dosing on same day as myelosuppressive chemotherapy for ovarian or primary peritoneal cancer. Support Oncol 7(6):225–228
21.
Lokich J (2006) Same day pegfilgrastim and CHOP chemotherapy for non-Hodgkin lymphoma. Am J Clin Oncol 29(4):361–363CrossRefPubMed
22.
Hoffman P (2005) Administration of pegfilgrastim on the same day or next day of chemotherapy. ASCO American Society of Clinical Oncology Annual Meeting #8137 (Abstract)
23.
Li Y, Klippel ZK, Shih X et al (2015) Effect timing of pegfilgrastim administration on absolute neutrophil count (ANC) trajectory among cancer patients (PTS) receiving myelosuppressive chemotherapy. J Clin Oncol 33(supple):e20674, Abstract
24.
Burris H III, Belani C, Kaufman P et al (2010) Pegfilgrastim on the same day versus next day of chemotherapy in patients with breast cancer, non-small-cell lung cancer, ovarian cancer, and non-Hodgkin’s lymphoma: results of four multicenter, double-blind, randomized phase II studies. J Oncol Pract 6(3):133–140CrossRefPubMedPubMedCentral
25.
Skarlos DV, Timotheadou E, Galani E et al (2009) Pegfilgrastim administered on the same day with dose-dense adjuvant chemotherapy for breast cancer is associated with a higher incidence of febrile neutropenia as compared to conventional growth factor support: matched case-control study of the Hellenic Cooperative Oncology Group. Oncology 77(2):107–112CrossRefPubMed
26.
Cheng C, Gallagher EM, Yeh J-Y et al (2014) Rates of febrile neutropenia with pegfilgrastim on same day versus next day of CHOP with or without rituximab. Anti-Cancer Drugs 25(8):964–969CrossRefPubMed
27.
Whitworth JM, Matthews KS, Shipman KA et al (2009) The safety and efficacy of day 1 versus day 2 administration of pegfilgrastim in patients receiving myelosuppressive chemotherapy for gynecologic malignancies. Gynecol Oncol 112(3):601–604CrossRefPubMed
28.
Gupta NK, Thorpe S, Vanderhoff P et al (2007) Pegfilgrastim can be effectively administered the same day as chemotherapy to prevent neutropenia-related complications. J Clin Oncol 25(18S):19571
29.
Belani CP, Ramalingam S, Al-Janadi A, Eskander E, Ghazal H, Schwartzberg L et al (2006) A randomized double-blind phase II study to evaluate same-day vs next-day administration of pegfilgrastim with carboplatin and docetaxel in patients with NSCLC. J Clin Oncol 24(suppl):7110, abstract
30.
Saven A, Schwartzberg L, Kaywin P et al (2006) Randomized, double-blind, phase 2, study evaluating same-day vs next-day administration of pegfilgrastim with R-CHOP in non-Hodgkin’s lymphoma patients. J Clin Oncol 24(suppl):7570, Abstract
31.
Kaufman PA, Paroly W, Rinaldi D (2004) Randomized double blind phase 2 study evaluating same-day vs. next-day administration of pegfilgrastim with docetaxel, doxorubicin and cyclophosphamide (TAC) in women with early stage and advanced breast cancer. San Antonio Breast Cancer Symposium. Breast Cancer Res Treat; 88. [Abstract 1054]
32.
33.
Weycker D, Li X, Edelsberg J et al (2015) Risk and consequences of chemotherapy-induced febrile neutropenia in patients with metastatic solid tumors. J Oncol Pract 11(1):47–54CrossRefPubMed
34.
Langeberg W, Siozon CC, Page JH et al (2014) Use of pegfilgrastim primary prophylaxis and risk of infection, by chemotherapy cycle and regimen, among patients with breast cancer or non-Hodgkin’s lymphoma. Support Care Cancer 22(8):2167–2175CrossRefPubMed
35.
Weycker D, Sofrygin O, Seefeld K et al (2013) Technical evaluation of methods for identifying chemotherapy-induced febrile neutropenia in healthcare claims databases. BMC Health Serv Res 13:60CrossRefPubMedPubMedCentral
36.
Dulisse B, Li X, Gayle JA et al (2013) A retrospective study of the clinical and economic burden during hospitalizations among cancer patients with febrile neutropenia. J Med Econ 16(6):1–16CrossRef
37.
Weycker D, Malin J, Edelsberg J et al (2008) Cost of neutropenic complications of chemotherapy. Ann Oncol 19(3):454–460CrossRefPubMed
38.
Lyman GH, Morrison VA, Dale DC et al (2003) Risk of febrile neutropenia among patients with intermediate-grade non-Hodgkin’s lymphoma receiving CHOP chemotherapy. Leuk Lymphoma 44:2069–2076CrossRefPubMed
Metadata
Title
Risk of chemotherapy-induced febrile neutropenia in cancer patients receiving pegfilgrastim prophylaxis: does timing of administration matter?
Authors
Derek Weycker
Xiaoyan Li
Jacqueline Figueredo
Rich Barron
Spiros Tzivelekis
May Hagiwara
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 5/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-3036-7

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