Neulasta® Facilitates Chemotherapy Administration and Reduces Febrile Neutropenic Hospitalizations
Researchers involved in an international randomized trial have reported that the prophylactic administration of Neulasta (pegfilgrastim) is associated with improved chemotherapy delivery, reduces febrile neutropenia (FN) and decreases hospitalization compared to current practice of neutropenia management. The details of this study were presented at the European CanCer Organization (ECCO) 14th European Cancer Conference meeting in Barcelona, Spain.[1]
ASCO and ASH guidelines recommend routine use of Neulasta® or Neupogen (filgrastim) for patients with an overall risk of FN of 20% or greater. Previous studies have suggested that prophylactic Neulasta can reduce the incidence of hospitalizations, decrease FN and allow better delivery of protocol doses of chemotherapy.
The current data was generated from 8 randomized clinical trials and 3 observational studies conducted between 1998 and 2005. There were 2,282 patients in this analysis with breast cancer, the majority of which were stage IV. The most common treatment regimens contained Taxotere (docetaxel). There were 1,303 patients in the Neulasta group and 979 in the no-Neulasta group. Two hundred and ten patients receiving Neulasta and 248 receiving no-Neulasta were prescribed prophylactic antibiotics in the original protocol. In cycle, 1.75% of no-Neulasta patients did not receive any therapeutic colony stimulating factor and 24% received either Neupogen or Neulasta. The following table summarizes the major finding of these analyses.
| Neulasta | Neulasta | No Neulasta | No Neulasta |
| Overall | Cycle 1 | Overall | Cycle 1 |
Dose delay >3 days in any cycle | 15% | NA | 16% | NA |
Dose reduction>15% in any cycle | 9% | NA | 24% | NA |
FN-related hospitalizations | 4% | 3% | 10% | 6% |
Antibiotics and/or antifungals | 42% | 22% | 55% | 43% |
These authors concluded that patients with breast cancer at moderate risk of FN benefited from prophylactic Neulasta by having a better delivery of chemotherapy and a reduced number of FN related hospitalizations.
Comments: These pooled data essentially corroborate individual reported studies (see related news).
Reference: Aspro M, Schwenkglenks M, Lyman G, et al. Improved chemotherapy delivery in breast cancer patients receiving pegfilgrastim prophylaxis compared with current practice neutropenia management – Results from an integrated analysis (NeuCuP). European Journal of Cancer Supplements 2007; 5:194. Abstract # 2033.
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