Germ cell tumors are common malignancies, and chemotherapy with a regimen of bleomycin, etoposide, and cisplatin (BEP) has improved the prognosis for patients with these tumors. However, BEP involves significant myelosuppression, and the safety of pegfilgrastim for the prevention of febrile neutropenia related to myelosuppression has not been well investigated in patients with this tumor type.
Germ cell tumors (GCTs) are common malignancies, and chemotherapy with a regimen of bleomycin, etoposide, and cisplatin (BEP) has improved the prognosis for patients with these tumors. However, BEP involves significant myelosuppression, and the safety of pegfilgrastim for the prevention of febrile neutropenia (FN) related to myelosuppression has not been well investigated in patients with this tumor type.
Researchers from Kanazawa University Hospital in Japan reported in In Vivo on their findings from the treatment of 10 patients with GCTs treated with BEP from 2014 to 2016. All of the patients received BEP every 3 weeks for 2 to 4 cycles. Pegfilgrastim was administered to 5 patients subcutaneously on day 7. Five patients received filgrastim.
The nadir absolute neutrophil count value was lower in those who used filgrastim than in those who used pegfilgrastim (P = .003). FN occurred in 2 cycles using filgrastim and in no cycles using pegfilgrastim. The duration of grade 2 to grade 4 neutropenia in cycles using filgrastim was longer than in those using pegfilgrastim (P = .01). No serious adverse events were observed.
The median number of days until maximum neutrophil count (MNC) in cycles using pegfilgrastim and filgrastim were 8 and 6, respectively. Interestingly, the MNC was recorded most frequently after pegfilgrastim injection in 85% of cycles that used pegfilgrastim. However, the MNC was recorded before filgrastim administration in 50% of cycles. “These results indicate that filgrastim injection may not be efficacious for increasing the neutrophil count in patients under BEP treatment,” wrote the authors.
The study was limited by its small size and by the fact that the median number of filgrastim administrations was 5 (while administration of pegfilgrastim is equivalent to an 11-day course of filgrastim). Larger prospective studies with longer follow-up periods will be needed to confirm the findings in this study, but the authors concluded that using pegfilgrastim with BEP for patients with GCTs may be an effective treatment for neutropenia that also has minimal toxicity.
Iwamoto H, Izumi K, Natsagdorj A, et al. Effectivness and safety of pegfilgrastim in BEP treatment for patients with germ cell tumor. In Vivo. 2018;32(4):899-903. doi: 10.21873/invivo.112326.