Real-world comparison of febrile neutropenia rates with same-day versus next-day administration of pegfilgrastim.

Abstract

299 Background: Febrile neutropenia (FN) is a common side effect of myelosuppressive chemotherapy. Per guidelines, prophylactic pegfilgrastim is to be given 24-72 hours after chemotherapy in each cycle, but administering pegfilgrastim within 24 hours of chemotherapy (same day) is commonly done to reduce the burden on patients (pts) and healthcare systems. The ideal timing is under debate in the supportive oncology care field, but an increasing body of knowledge supports same-day administration as an option. The objective of this study was to compare the incidence of FN after same-day vs next-day administration of pegfilgrastim in pts with cancer receiving cytotoxic chemotherapy. Methods: A real-world, retrospective study of electronic health records of pts treated at Utah Cancer Specialists (Salt Lake City, UT) between February 2018 and December 2020 was conducted. Pts included in the study had a diagnosis of breast cancer, diffuse large B-cell lymphoma, or other cancers (eg. other lymphomas, prostate cancer); received a myelosuppressive chemotherapy regimen; and were administered either same-day or next-day prophylactic pegfilgrastim. FN was physician diagnosed; differences in FN incidence with same-day vs next-day pegfilgrastim were evaluated using a Chi-square test and Wald confidence limits. Results: 297 pts were included in this analysis. Most pts (63.6%) had a diagnosis of breast cancer, 23.6% had lymphoma, and 12.8% had other cancers. Pts received a broad range of chemotherapy regimens, with dose-dense doxorubicin and cyclophosphamide being the most common (43.4%). In cycle 1, pegfilgrastim administration timing was balanced between same-day (39.7% [118/297]) and next-day (60.3% [179/297]). The pegfilgrastim administration day changed in subsequent cycles in 27 pts (9.1%): 4 pts in the cycle 1 same-day group and 23 pts in the cycle 1 next-day group. In cycle 1, 7/117 pts (6.0%) in the same-day pegfilgrastim group and 12/180 (6.7%) pts in the next-day group experienced ≥1 episode of FN. Across all cycles, 11/118 pts (9.3%) in the same-day pegfilgrastim group and 16/179 (8.9%) pts in the next-day group experienced ≥1 episode of FN. The difference in incidence of FN between same-day vs next-day pegfilgrastim was not statistically significant in cycle 1 (0.68% [95% CI –5.0% to 6.3%]; P=.814) and across all cycles (–0.38% [95% CI –7.1% to 6.3%]; P=.910). Conclusions: The overall incidence of FN was low in this pt population receiving prophylactic pegfilgrastim, and no significant differences were detected between same-day and next-day pegfilgrastim administration. These data support the same-day administration of prophylactic pegfilgrastim.