Appropriateness of using granulocyte colony-stimulating factor (G-CSF) for primary prophylaxis of febrile neutropenia in solid tumors

2019 ◽  
Vol 26 (2) ◽  
pp. 428-433
Author(s):  
Elahe Laali ◽  
Jinous Fazli ◽  
Sanambar Sadighi ◽  
Mehdi Mohammadi ◽  
Kheirollah Gholami ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Solid Tumors ◽  
Prospective Observational Study ◽  
Cost Savings ◽  
Primary Prophylaxis ◽  
Granulocyte Colony Stimulating Factor ◽  
Substantial Cost ◽  
Prescription Pattern ◽  
Study Population ◽  
Stimulating Factor

Introduction Febrile neutropenia (FN) is one of the dose-limiting adverse effects of chemotherapy. Granulocyte-Colony Stimulating Factors (G-CSFs) minimize the incidence of FN and reduce the risk of neutropenia complications. This study was conducted to address the prescription pattern of G-CSF for primary prophylaxis of FN during the first cycle of chemotherapy in solid tumors. Method This prospective observational study was done to investigate the G-CSF prescription pattern in patients receiving the first cycle of chemotherapy for solid tumors and compare it with the NCCN guideline recommendations. Result Based on the guideline, prophylactic G-CSF administration was indicated in 26 of the 96 patients (27.1%) and all of them received G-CSF. On the other hand, 70 patients (72.9%) did not meet the guideline criteria for prophylaxis, but 60 (62.5%) of them received G-CSF. Seven doses of pegfilgrastim and 165 doses of filgrastim were used inappropriately in the study population, which was associated with an economic burden of about 224.7 million IRR (5350 USD). Conclusion Taken together, inconsistencies with the guideline were observed in this prospective evaluation, suggesting that submitting rationalized policies to decrease G-CSF prescription, especially in patients with a lower or intermediate FN risk, yields substantial cost savings.

scholarly journals Clinical practice in febrile neutropenia risk assessment and granulocyte colony-stimulating factor primary prophylaxis of febrile neutropenia in Poland

2014 ◽  
Vol 6 ◽  
pp. 419-424
Author(s):  
Marek Wojtukiewicz ◽  
Ewa Chmielowska ◽  
Emilia Filipczyk-Cisarż ◽  
Krzysztof Krzemieniecki ◽  
Krzysztof Leśniewski-Kmak ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Febrile Neutropenia ◽  
Primary Prophylaxis ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Stimulating Factor

Febrile Neutropenia Risk Assessment and Granulocyte-Colony Stimulating Factor Support in Patients with Diffuse Large B Cell Lymphoma Receiving R-CHOP Regimens.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 107-107 ◽  
Author(s):  
Antonio Salar ◽  
Corinne Haioun ◽  
Francesca Gaia Rossi ◽  
Ulrich Duehrsen ◽  
Ruth Pettengell ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Research Funding ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Primary Prophylaxis ◽  
Granulocyte Colony Stimulating Factor ◽  
Large B Cell Lymphoma ◽  
The Mean ◽  
Stimulating Factor ◽  
Large B Cell

Abstract Abstract 107 BACKGROUND: ASCO and EORTC guidelines recommend granulocyte colony-stimulating factor (G-CSF) primary prophylaxis for cancer patients with a ≥20% overall risk of febrile neutropenia (FN), and to support delivery of dose-dense regimens. CHOP-like regimens (with rituximab [R]) are the current standard of care for the management of aggressive non-Hodgkin lymphoma (NHL), but they are often associated with significant myelosuppression. Neutropenic events, particularly febrile neutropenia (FN), can be life-threatening and may lead to dose delays or reductions that compromise the efficacy of chemotherapy. In IMPACT NHL, we evaluated current practice in FN risk assessment and use of G-CSF prophylaxis in patients receiving (R)CHOP. METHODS: IMPACT NHL is a retrospective and prospective observational study conducted in 14 European countries and Australia. Physicians assessed the overall FN risk of NHL patients and their need for G-CSF prophylaxis. This analysis focuses on patients with diffuse large B-cell lymphoma (DLBCL) receiving either 2-weekly R-CHOP-14 or 3-weekly R-CHOP-21. FN risk was assessed according to EORTC guidelines (i.e. the total risk from the chemotherapy regimen plus individual patient risk factors). The primary outcome measure was the proportion of patients assessed as being at ≥20% risk of FN and who were planned to receive primary prophylaxis with a G-CSF (defined as G-CSF initiation within days 1-7 of cycle 1). RESULTS: Data were available for 1829 patients who initiated chemotherapy between 01/2005 and 08/2008; 1136 had DLBCL. The mean age±SD of patients receiving R-CHOP-21 (N=704) was 62.6±13.8 years, 51% were aged ≥65 years and 53% had Stage III-IV disease. For R-CHOP-14 patients (N=409), the mean age was 58.4±14.7 years, 41% were ≥65 years and 59% had Stage III-IV disease. In total, 434 R-CHOP-21 patients were assessed as being at high risk for FN and 47% of them actually received G-CSF primary prophylaxis (with either pegfilgrastim or daily G-CSF) (see Table). Furthermore, almost a fifth of patients assessed as being at <20% FN risk received G-CSF primary prophylaxis. Across all cycles, 29% of R-CHOP-21 patients had an unplanned hospitalization, with neutropenia/FN being the main reason. Subsequently, 67% of patients achieved a relative dose intensity (RDI) of ≥90% of their planned treatment (with respect to cyclophosphamide, doxorubicin, and vincristine). In the R-CHOP-14 group, 16% of patients did not receive G-CSF primary prophylaxis; 32% had an unplanned hospitalization and 59% of patients achieved '90% of their planned RDI. CONCLUSIONS: Half of R-CHOP-21 patients assessed as high risk for FN did not receive G-CSF primary prophylaxis despite physicians' awareness of elevated risk, while primary G-CSF support was not given to almost one fifth of R-CHOP-14 patients, contrary to guideline recommendations. Both R-CHOP-14 and R-CHOP-21 resulted in significant myelotoxicity (with substantial FN even in those evaluated as being at lower risk), and only around two-thirds of patients received optimal chemotherapy RDI. Our data suggest that improvements in neutropenia management are required. More consistent use of G-CSF primary prophylaxis may further reduce FN and assist in optimal chemotherapy delivery. Sponsored by Amgen Disclosures: Salar: Amgen: Honoraria. Haioun:Roche: Research Funding; Amgen: Other, Research Funding; Celgene: Other, Research Funding; Mundipharma: Research Funding. Pettengell:Amgen: Honoraria, Speakers Bureau; Roche: Honoraria, Speakers Bureau; Bayer: Honoraria, Speakers Bureau. Jaeger:Amgen: Research Funding. Schwenkglenks:Amgen: Honoraria, Research Funding. Bacon:Amgen: Employment, Equity Ownership. Bendall:Amgen: Employment.

The Use of Prophylactic Granulocyte-colony Stimulating Factor for Chemotherapy-induced Febrile Neutropenia

2012 ◽  
Vol 08 (01) ◽  
pp. 14 ◽  
Author(s):  
Shiva Natarajan ◽  
Shruthi Narayan ◽  
John A Liu Yin ◽  
Angela Chan ◽  
◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Primary Prophylaxis ◽  
Individual Characteristics ◽  
Granulocyte Colony Stimulating Factor ◽  
Mortality Factors ◽  
Tumour Type ◽  
Dose Dense ◽  
Patient At Risk ◽  
Effective Use ◽  
Stimulating Factor

Febrile neutropenia (FN) is a common and serious complication of cytotoxic chemotherapy. It impairs the immune system, placing the cancer patient at risk of infection and is a key contributor to chemotherapy-associated morbidity and mortality. Factors including therapeutic regimen, tumour type and individual characteristics influence susceptibility to myelosuppression. Over the years, several granulocyte-colony stimulating factors (G-CSFs) have been developed for primary prophylaxis of FN including filgrastim, lenograstim and pegfilgrastim. These agents have demonstrated safety and efficacy in reducing FN in patients allowing for administration of optimal treatment and thereby improving clinical outcomes. They also support the use of dose-dense and dose-intense chemotherapy regimens found to be beneficial in some patients. Recently, the introduction of biosimilars of G-CSFs with proven comparability with the originator filgrastim has expanded the prophylactic therapies available. Effective use of these drugs by physicians early in the chemotherapy schedule may lead to fewer adverse events and improved survival.

scholarly journals Appropriateness of granulocyte colony-stimulating factor use in patients receiving chemotherapy by febrile neutropenia risk level

2018 ◽  
Vol 25 (7) ◽  
pp. 1576-1585 ◽  
Author(s):  
Hassam Baig ◽  
Barbara Somlo ◽  
Melissa Eisen ◽  
Scott Stryker ◽  
Mark Bensink ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Solid Tumors ◽  
Low Risk ◽  
Hodgkin's Lymphoma ◽  
Intermediate Risk ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Non Hodgkin's Lymphoma ◽  
Stimulating Factor

ObjectiveInappropriate granulocyte colony-stimulating factor use with myelosuppressive chemotherapy has been reported. Using the Oncology Services Comprehensive Electronic Records electronic medical record database, prophylactic granulocyte colony-stimulating factor (pegfilgrastim/filgrastim) use in cancer patients was assessed by febrile neutropenia risk level.MethodsPatients with nonmetastatic or metastatic breast, head/neck, colorectal, ovarian/gynecologic, lung cancer, or non-Hodgkin’s lymphoma who received myelosuppressive chemotherapy from June 2013 to May 2014 were included. Prophylactic granulocyte colony-stimulating factor use with high-risk, intermediate-risk, and low-risk chemotherapy and distribution of National Comprehensive Cancer Network risk factors with intermediate-risk regimens were assessed.ResultsOverall, 86,189 patients received ∼4.2 million chemotherapy cycles (high risk, 9%; intermediate risk, 48%; low risk, 43%). Prophylactic granulocyte colony-stimulating factor was given in 24% of cycles (high risk, 59%; intermediate risk, 29%; low risk, 11%). For nonmetastatic solid tumors, granulocyte colony-stimulating factor was given in 78% (high risk), 31% (intermediate risk), and 6% (low risk) of cycles. For metastatic solid tumors or non-Hodgkin’s lymphoma, granulocyte colony-stimulating factor was given in 50% (high risk), 27% (intermediate risk), and 11% (low risk) of cycles. Among patients receiving intermediate-risk regimens with granulocyte colony-stimulating factor, febrile neutropenia risk factors were identified in 56% (95% confidence interval, 51.1–60.9%) of patients with nonmetastatic solid tumors (n = 400) and in 70% (64.5–73.5%) of patients with metastatic solid tumors or non-Hodgkin’s lymphoma (n = 400).ConclusionProphylactic granulocyte colony-stimulating factor use was appropriately highest for high-risk regimens and lowest for low-risk regimens yet still potentially underused in high risk regimens, overused in low-risk regimens, and not appropriately targeted in intermediate-risk regimens, indicating a need for further education on febrile neutropenia risk evaluation and appropriate granulocyte colony-stimulating factor use.

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