Abstract
PurposeTo evaluate patterns of primary prophylactic (PP) granulocyte colony–stimulating factor (G-CSF) use following chemotherapy by cancer type and febrile neutropenia (FN) risk.MethodsUsing a commercial administrative database, we identified adult patients diagnosed with breast, colorectal, lung, ovarian cancer, or non-Hodgkin lymphoma (NHL) who initiated chemotherapy with high risk (HR) or intermediate risk (IR) for FN between January 1, 2013, and August 31, 2017. We describe use of PP-G-CSF, proportion completing all their cycles with pegfilgrastim, timing of pegfilgrastim, and duration of short-acting G-CSF.ResultsAmong 22,868 patients (breast 11,513; colorectal 3765; lung 4273; ovarian 1287; and NHL 2030), 36.8% received HR and 63.2% received IR (64.4% of whom had ≥ 1 risk factor [RF] for FN). Proportions of patients receiving PP-G-CSF in the first cycle were 76.1%, 28.2%, and 26.4% among patients receiving HR, IR, and IR plus ≥ 1 RF, respectively. Among breast cancer patients receiving HR regimens and initiating PP-pegfilgrastim, 60.4% (95% confidence interval [CI] 57.2–63.6%) initiating via on-body injector (OBI) and 51.9% (95% CI 48.0–55.8%) initiating via prefilled syringe (PFS) completed all their cycles with OBI and PFS, respectively. Among all cycles with PP-PFS, 8.5% received PFS on the same day as chemotherapy completion. Mean administrations/cycle were 3.2 (standard deviation [SD] 2.3) for filgrastim, 3.0 (SD 1.6) for filgrastim-sndz, and 4.3 (SD 2.5) for tbo-filgrastim.ConclusionsThere is under- and mistimed use of PP-G-CSF among patients at HR for FN. Novel pegfilgrastim delivery devices could help breast cancer patients at HR for FN complete all their cycles with timely prophylaxis.
Highlights
Scientific discovery is leading to rapid advances in our understanding of cancer and is delivering new targeted medicines [1,2,3], leading to substantial clinical benefit
We identified patients ≥ 18 years of age diagnosed with breast, colorectal, lung, ovarian cancer, or non-Hodgkin lymphoma (NHL) who had initiated myelosuppressive chemotherapy regimens with high/intermediate risk for febrile neutropenia (FN) as defined in the 2017 v2
Chemotherapy regimens with high FN risk were most common in breast cancer patients (71.8%) compared with ≤ 6% for patients with other cancer types (Online Resource 8)
Summary
Scientific discovery is leading to rapid advances in our understanding of cancer and is delivering new targeted medicines [1,2,3], leading to substantial clinical benefit. There have been important developments in recent years regarding FN management, including greater focus placed on high-quality, low-cost cancer care through efforts such as the Oncology Care Model (OCM) by the Centers for Medicare and Medicaid Services (CMS) [11], the entrance of biosimilars of filgrastim [12,13,14] and pegfilgrastim [15, 16] in the USA, and the introduction of new, patient-centric drug delivery devices [17] The effects that these changes have had on prescribing patterns and persistence with chemotherapy regimens are largely unknown but are important to establish for future requisite investigations into the clinical consequences of such therapeutic decisions
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