Same-day pegfilgrastim to combat febrile neutropenia in conjunction with myelosuppressive chemotherapy (CTX) is safe, investigators conclude.
Same-day vs next-day administration of pegfilgrastim as prophylaxis against febrile neutropenia (FN) in patients undergoing myelosuppressive chemotherapy (CTX) shows promise despite preexisting concerns this may increase the incidence of FN, investigators reported in studies of patients with lung and breast cancer presented at the ASCO 2021 Annual Meeting.
With the savings biosimilars afford and in a country emerging from the COVID-19 pandemic, same-day treatment appears to make economic and practical sense, they said.
Findings from a retrospective study at the University of Arizona suggest that for patients with lung cancer, same day treatment with pegfilgrastim “provides a unique opportunity for cancer care without concerns for FN,” investigators wrote.
Guidelines suggest that pegfilgrastim be administered 24 hours after myelosuppressive chemotherapy (CTX), and data from previous studies had not clarified the utility of same-day vs next-day pegfilgrastim use for this class of patients, they said.
They included 114 patients who met the inclusion criteria; 76% (n = 87) of patients had non–small cell lung cancer and 24% (27) had small cell lung cancer. Of those, 52% had stage III/IV cancer and 63% had ECOG status of 0 to 1.
Study authors said 72% of patients had mild FN risk, mean standard deviation absolute neutrophil count at baseline was 5.68, and 384 CTX cycles were received in total.
One patient developed FN after the first cycle of CTX of irinotecan and, across all cycles, 5 patients developed 6 FN episodes.
Two of those patients were on carboplatin etoposide, 1 was on cisplatin etoposide, and 1 on vinorelbine. For the patient who experienced 2 episodes of FN, these occcured following a switch from pemetrexed to irinotecan CTX.
Vraney J, AlRawashdh N, Choi B, Abraham I, McBride A. An institutional evaluation of the safety and efficacy of same-day administration of pegfilgrastim in patients receiving chemotherapy for lung cancer. Presented at: ASCO 2021: June 3-7, 2021. Abstract e18591
In patients with breast cancer, pegfilgrastim biosimilar (Udenyca) administered as prophylaxis for FN on the same day as CTX appears to be safe and effective, investigators wrote. “Previous literature has indicated that pegfilgrastim administration prior to 24 hours post chemotherapy may result in a deepened and prolonged neutropenia due to the increase in circulating granulocytes exposed to chemotherapy.”
Oncologists at Inova Schar Cancer Institute in Fairfax, Virginia, conducted a retrospective chart review of 55 patients treated by 4 medical oncologists in the center’s breast cancer group. They said 16.4% of patients experienced grade 3/4 FN and 10.9% (n = 6) were hospitalized. There were no grade 5 events and FN was not the cause of therapy discontinuation for any of the patients. “Of note, there were no cases of COVID-19 among the 9 patients who had an episode of FN.”
They said 94.5% (n = 52) of patients included in the study received treatment with curative intent and 5.5% (n = 3) had metastatic disease in subsequent lines of therapy.
“Same day pegfilgrastim-cbqv appears to be a safe and effective option in the primary and secondary prophylaxis of FN with myelosuppressive standard of care chemotherapy used in breast cancer treatment,” they concluded.
They cautioned that their study was confined to a relatively small sample of patients and a young age group (median age, 49.1).
“This opens the door to further re-evaluation of same day [Udenyca] administration in other patient populations. In a postpandemic treatment world, this slight change in practice has the potential to reduce patient financial toxicity associated with multiple medical visits, provide an alternative to on-body injector formulations, and ensure treatment adherence,” they said.
Leiva M, Pennisi A, Kiernan Harnden K, Rizzo PC, Mauro LA. The feasibility of same day pegfilgrastim-cbqv administration in breast cancer patients receiving myelosuppressive chemotherapy regimens at a northern Virginia cancer center. Presented at: ASCO 2021: June 3-7, 2021. Abstract e18687