Pegfilgrastim: a granulocyte colony-stimulating factor with sustained duration of action

Granulocyte colony-stimulating factors such as filgrastim (Neupogen, Amgen, Inc.) and pegfilgrastim (Neulasta, Amgen, Inc.) are frequently used in clinical practice for the prevention of chemotherapy-induced neutropenia and its potentially life-threatening complications. Due to its unique neutrophil-mediated clearance, pegfilgrastim can be administered once per chemotherapy cycle. Clinical trials have shown that a single, fixed subcutaneous dose of pegfilgrastim 6 mg is comparable in safety and efficacy to daily injections of filgrastim for decreasing the incidence of infection following myelosuppressive chemotherapy in patients with cancer. Postregistrational trials have been conducted to evaluate the use of pegfilgrastim with emerging dose-dense regimens, in myeloid cancers and for mobilisation and engraftment of autologous stem cells. Ongoing clinical trials continue to explore further potential uses for pegfilgrastim.

Palliative care in patients with brain metastases

PURPOSE OF REVIEW

With improvements in systemic therapy, central nervous system metastases have increased in incidence in patients with cancer. Patients with brain metastases from solid tumors often have a dismal prognosis, and supportive measures are often critical in improving patient outcome. They include treatments against vasogenic edema, seizures, symptomatic venous thrombosis, and pain, and the management of iatrogenic side effects. This article reviews all the supportive care measures in patients with brain metastases, with the exception of tumor-specific chemotherapy treatments that are also used in this patient population.

RECENT FINDINGS

Recently, improvement has been made in the management of the following complications of brain metastases: epilepsy and antiepileptic drug side effects, thromboembolic complications, fatigue and cognitive disorder of mixed (tumoral and/or iatrogenic) origin, pain, hematological side effects of chemotherapy, and steroids complications.

SUMMARY

Patients with brain metastases are particularly prone to develop severe side effects, increased fatigue, and cognitive deteriorations following apparently minor changes in symptomatic treatments. Palliative management of brain metastasis requires a multidisciplinary approach, and it is important to avoid any treatment that is useless or harmful or has a poor toxicity/efficacy ratio.