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Gascón P, Harbeck N, Rapoport BL, Anderson R, Brueckmann I, Howe S, Aapro M. Filgrastim biosimilar (EP2006): A review of 15 years' post-approval evidence. Crit Rev Oncol Hematol 2024; 196:104306. [PMID: 38401695 DOI: 10.1016/j.critrevonc.2024.104306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Filgrastim is approved for several indications, including reduction of the incidence and duration of chemotherapy-induced neutropenia and for stem cell mobilization. The filgrastim biosimilar, EP2006, has been available in Europe since 2009, and in the United States since 2015. In this time, preclinical and clinical data used to support the approval of EP2006 have been published. These data established the biosimilarity of EP2006 to reference filgrastim in terms of structure, pharmacokinetics, pharmacodynamics, efficacy, safety, and immunogenicity. Additional real-world evidence studies have also demonstrated equivalent efficacy and safety of EP2006 compared with reference filgrastim, both in the reduction of neutropenia and in stem cell mobilization in clinical practice. This review summarizes these preclinical, clinical, and real-world data, as well as the available cost-effectiveness data, for EP2006 since its approval 15 years ago.
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Affiliation(s)
- Pere Gascón
- Division of Medical Oncology, IDIBAPS, Hospital Clinic, Casanova 143, Barcelona 08036, Spain
| | - Nadia Harbeck
- Breast Center, Department OB&GYN and Center for hereditary Breast and Ovarian Cancer, LMU University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Bernardo L Rapoport
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Johannesburg 2196, South Africa; Department of Immunology, Pathology Building, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Ronald Anderson
- Department of Immunology, Pathology Building, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Ines Brueckmann
- Sandoz Group AG, Global Medical Affairs, Industriestr. 25, Holzkirchen D-83607, Germany
| | - Sebastian Howe
- Sandoz Group AG, Global Medical Affairs, Industriestr. 25, Holzkirchen D-83607, Germany.
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Route du Muids 3, Genolier 1272, Switzerland
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China Anti-Cancer Association Tumor Clinical Chemotherapy Professional Committee, China Anti-Cancer Association Tumor Support Therapy Professional Committee. [Consensus on clinical diagnosis, treatment, and prevention of chemotherapy-induced neutropenia in China (2023 edition)]. Zhonghua Zhong Liu Za Zhi 2023; 45:575-83. [PMID: 37460439 DOI: 10.3760/cma.j.cn112152-20230224-00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Chemotherapy-induced neutropenia (CIN) is a common hematological adverse events and dose-limiting toxicities of chemotherapy. CIN may lead to dose reduction and delay of chemotherapeutic agents, febrile neutropenia and severe infection, which results in increased treatment cost, reduced efficacy of chemotherapy, and even life-threatening morbidities. Assessment of risk of CIN, early detection of FN and infection, and proper prevention and treatment play a crucial role in reducing the occurrence of CIN-related morbidities, improving patient treatment safety and anticancer efficacy. Based on evidence and expert opinion, the expert committee of Chinese Anti-Cancer Association issued "the consensus on diagnosis and treatment of chemotherapy-induced neutropenia in China (2023 edition)", which is an update version of the 2019 edition, aiming to provide reference for the diagnosis and treatment of CIN for Chinese oncologists.
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Miyagi T, Tsuji D, Kawasakai Y, Ishikawa H, Tanaka R, Nakao M, Nakagaki S, Hayashi T, Ayuhara H, Harada T, Tamaki S, Maeda A, Ohashi Y, Arakawa Y, Fujita Y, Yamamoto K, Miyamoto Y, Yano T, Itoh K. Chemotherapy-induced neutropenia as a prognostic factor in patients with extensive-stage small cell lung cancer. Eur J Clin Pharmacol 2023; 79:407-14. [PMID: 36645467 DOI: 10.1007/s00228-023-03451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Chemotherapy-induced neutropenia (CIN) is a dose-limiting factor for cytotoxic chemotherapy, but recently, it was suggested that CIN contributes to prolonged survival. In this study, we examined the association between severe CIN and survival and determined whether CIN affected survival in patients with extensive-stage small cell lung cancer (ES-SCLC). METHODS The medical records from 214 patients with ES-SCLC treated with etoposide or irinotecan in combination with cisplatin (EP/IP) between 2012 and 2016 were collected and retrospectively analyzed. Landmark analysis was performed at the end of cycle 4, and the relationship between severe CIN and survival was determined by a log-rank test. In addition, a multivariate analysis using the COX proportional hazard model was performed to identify independent predictive factors. The Landmark analysis included 102 patients in the IP group and 47 patients in the EP group. RESULTS No significant difference was found between grades 0-3 and grade 4 neutropenia and overall survival (OS) in the EP group (P = 0.57). Contrariwise, for the IP patients, the median OS was 444 days for grades 0-3 and 633 days for grade 4 neutropenia, which was significantly longer for patients who developed grade 4 neutropenia (P = 0.03). Multivariate analysis adjusted for potential factors revealed that the development of grade 4 CIN was identified as a significant predictor of longer OS (hazard ratio [HR], 0.50; 95% confidence interval (CI), 0.28-0.87, P = 0.015). CONCLUSION The results indicated that the development of severe CIN with IP therapy is associated with prolonged OS.
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Kiechle M, Schem C, Lüftner D, Hipp J, Stetzer E, Köhler U. Prophylaxis of Neutropenia with Lipegfilgrastim in Breast Cancer Patients with Dose-Dense Chemotherapy: Results of a Noninterventional Study on Therapeutic Routine in Germany (NADENS). Breast Care (Basel) 2022; 17:508-513. [PMID: 36684406 PMCID: PMC9851063 DOI: 10.1159/000524984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/10/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Noninterventional study (NIS) on application and effectiveness of primary G-CSF prophylaxis with lipegfilgrastim in primary breast cancer patients undergoing dose-dense (dd) or intense-dose-dense (idd) chemotherapy (CTx) regimen in daily clinical practice. Methods Prospective, multicenter, single-arm, NIS in 41 private practices and 27 hospitals in Germany. Results Data analysis of 282 patients with a mean age of 49 years (93.6% of patients <65 years) was performed. Hormone receptor status was triple negative in 29.8% of patients, and 81.9% of patients were HER2 negative. A total of 73.8% of patients received "EC dd → taxane CTx." Patients received lipegfilgrastim prophylaxis in 97.5% of 1,121 documented dd/idd cycles. Overall, the study registered 275 events of SN (CTCAE grade 3 or 4) and 9 events of FN. During the first dd cycle, SN occurred in 33.3% and FN in 1.1% of patients. CTx delay or dose reduction due to neutropenia was required in 2.5% of patients during the 4 dd cycles with lipegfilgrastim support. Overall, 314 adverse events (AEs) were reported from 107 patients and 27 serious AEs from 21 patients. None of the SAEs was "fatal," and CTCAE grade was mostly (89.6%) assessed as "1" or "2." According to the treating physicians, 99.3% of all patients benefitted from lipegfilgrastim prophylaxis, and tolerability was mostly rated "very good" or "good." Conclusion These results suggest that primary lipegfilgrastim prophylaxis is effective and safe in clinical routine and is beneficial in primary breast cancer patients undergoing dd/idd-ETC CTx.
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Affiliation(s)
- Marion Kiechle
- aFrauen- und Poliklinik, Technische Universität München, Munich, Germany
| | - Christian Schem
- bMammazentrum Hamburg am Krankenhaus Jerusalem, Hamburg, Germany
| | - Diana Lüftner
- cKlinik für Hämatologie und Onkologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Uwe Köhler
- fKlinik für Gynäkologie und Geburtshilfe, Klinikum St. Georg, Leipzig, Germany
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Kim H, Mousa SA. Colony stimulating factors for prophylaxis of chemotherapy-induced neutropenia in children. Expert Rev Clin Pharmacol 2022; 15:977-986. [PMID: 35929962 DOI: 10.1080/17512433.2022.2110066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Febrile neutropenia (FN) is one of the complications of chemotherapy that can increase the risk of infection and mortality. Granulocyte colony-stimulating factors (G-CSFs) are used in practice to prevent and treat episodes of neutropenia. The use of G-CSFs in children with cancer has not been studied much for primary prophylaxis of FN. AREAS COVERED Current data suggest that G-CSFs have a similar pharmacokinetic profile in children and adults. Clinical trials published from 2002 to 2021 using G-CSFs in pediatric cancer patients were reviewed. All evaluated clinical trials used a dosage of 5 mcg/kg of filgrastim daily until neutrophil recovery or a single dose of 100 mcg/kg pegfilgrastim. Filgrastim demonstrated the benefit in decreasing the duration of fever, hospital stay, and antibiotic use in high-risk neuroblastoma patients. Pegfilgrastim showed similar efficacy in reducing the occurrence of FN and infections, with bone pain as an adverse effect. EXPERT OPINION Filgrastim 5 mcg/kg/day or pegfilgrastim 100 mcg/kg single dose is appropriate when given at least 24 hours or after the chemotherapy in pediatric patients who weigh 45 kg or more. More prospective randomized trials are necessary to further investigate the efficacy and safety of G-CSFs in children with different types of cancer.
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Affiliation(s)
- Heeyeon Kim
- The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, NY USA
| | - Shaker A Mousa
- The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, NY USA
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Al Qadire M, Ballad CAC, Aljezawi M, Al Omari O, Alaloul F, Musa A, Al Sabei S, Khalaf A. Nurses' knowledge of chemotherapy-induced neutropenia and its management: a cross-sectional survey. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04140-9. [PMID: 35819525 DOI: 10.1007/s00432-022-04140-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chemotherapy-induced neutropenia (CIN) is a serious and potentially life-threatening condition that is associated with high morbidity, mortality, and healthcare costs. OBJECTIVE This study aims to assess nurses' level of knowledge of CIN and its association with socio-demographic factors. METHODS A cross-sectional survey design was used. RESULTS Participants had a mean age of 34.1 years (SD = 7.1 years) and were predominantly female (78%) and with a bachelor's degree in nursing (95.6%). The nurses had a moderate level of knowledge about neutropenia and its management (mean total score 16.3 out of 30, SD = 3.7). Those who had a post-graduate degree (P = .048), had received an oncology educational course (P = .011), had attended a course on neutropenia (P = .007), who were working in an oncology unit (P = .002), and had more oncology experience (P = 001) were more likely to have a higher level of knowledge of CIN and its management compared to their other counterparts. CONCLUSION Based on the findings of a moderate level of knowledge of CIN among nurses, the findings call for the need for further education and training. As a long-term plan, this might be accomplished by encouraging nurses to pursue post-graduate education or oncology-specialized certification and supporting them with scholarship grants. However, deliberate plans for short courses, training and workshops on oncology or CIN are other choices with a more immediate impact on nurses' knowledge and clinical practice. Finally, integrating oncology nursing education within nursing curricula is urgently needed.
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Affiliation(s)
- Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, PC 123, P.O. Box 66, Muscat, Sultanate of Oman.,Faculty of Nursing, Al Al-Bayt University, P.O. Box 130040, Mafraq, 25113, Jordan
| | - Cherry Ann C Ballad
- College of Nursing, Sultan Qaboos University, PC 123, P.O. Box 66, Muscat, Sultanate of Oman
| | - Ma'en Aljezawi
- College of Nursing, Sultan Qaboos University, PC 123, P.O. Box 66, Muscat, Sultanate of Oman.,Faculty of Nursing, Al Al-Bayt University, P.O. Box 130040, Mafraq, 25113, Jordan
| | - Omar Al Omari
- College of Nursing, Sultan Qaboos University, PC 123, P.O. Box 66, Muscat, Sultanate of Oman
| | - Fawwaz Alaloul
- College of Nursing, Sultan Qaboos University, PC 123, P.O. Box 66, Muscat, Sultanate of Oman
| | - Ahmad Musa
- Faculty of Nursing, Al Al-Bayt University, P.O. Box 130040, Mafraq, 25113, Jordan
| | - Sulaiman Al Sabei
- College of Nursing, Sultan Qaboos University, PC 123, P.O. Box 66, Muscat, Sultanate of Oman
| | - Atika Khalaf
- College of Nursing, Sultan Qaboos University, PC 123, P.O. Box 66, Muscat, Sultanate of Oman. .,Faculty of Health Sciences, Kristianstad University, Elmetorpsvägen 15, 291 88, Kristianstad, SE, Sweden.
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Abstract
INTRODUCTION A decrease in relative-dose intensity (RDI) of chemotherapy has been shown to be associated with poor patient outcomes in solid tumors and non-Hodgkin's lymphoma. The actual delivered chemotherapy dose received by patients can be influenced by dose reductions and treatment delays, often due to toxicities, most commonly chemotherapy-induced neutropenia (CIN). AREAS COVERED We review seminal evidence and more recent studies that have shown an association between higher RDI and improved patient survival. A smaller number of studies has shown no association between RDI and outcomes. These differences may be due to study limitations, including low power, differences in patient and disease characteristics, or the chemotherapeutic regimen. We describe guidelines recommendations to prevent and treat CIN with granulocyte-colony stimulating factor (G-CSF) and describe novel approaches to prevent neutropenia that are being developed that may provide greater value and be associated with fewer adverse events than standard G-CSF options. EXPERT OPINION Maintaining RDI is important to ensure optimal patient outcomes. This can be achieved through the proper administration of G-CSF prophylaxis and treatment. Newer agents in development to treat and/or prevent CIN are entering regulatory review and may potentially change the treatment landscape for CIN in the future.
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Affiliation(s)
| | - R Donald Harvey
- Winship Cancer Institute and Emory University School of Medicine, Department of Hematology and Medical Oncology, Atlanta, GA, USA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, The University of Washington, Seattle, WA, USA
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Han Y, Liu Y, Ma X, Shen A, Liu Y, Weeranoppanant N, Dong H, Li Y, Ren T, Kuai L, Li B, An M, Li Y. Antibiotics armed neutrophils as a potential therapy for brain fungal infection caused by chemotherapy-induced neutropenia. Biomaterials 2021; 274:120849. [PMID: 34022739 DOI: 10.1016/j.biomaterials.2021.120849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 12/17/2022]
Abstract
Chemotherapy-induced neutropenia, a symptom of neutrophil depletion, makes cancer patients highly susceptible to invasive fungal infection with substantial morbidity and mortality. To address the cryptococcal brain infection in this condition, this study attempts to arm neutrophils (NEs) with antibiotics to potentiate the antifungal capability of NEs. To allow effective integration, amphotericin B, a potent antibiotic, is assembled with albumin nanoparticles through hydrophobic and hydrogen-bond interactions to form AmB@BSA nanoparticles (A-NPs). The nutrient composition (albumin) and virus-like size (~40 nm) facilitate efficient uptake of A-NPs by NEs to construct the antibiotics-armed NEs. It is demonstrated that the armed NEs can maintain the intrinsic biological functions of NEs, such as cell viability and capacity of migration to an inflammatory site. In a neutropenic mouse model of brain fungal infection, the treatment with the armed NEs allows for preventing fungal invasion more effectively than that with the native NEs, without the apparent systemic toxicity. Such a synergistic anti-infection system maximizes the antifungal effects by taking advantage of NEs and antibiotics. It provides a potential NEs-mediated therapeutic approach for treating fungal infection caused by chemotherapy-induced neutropenia.
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Affiliation(s)
- Yi Han
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Yanchao Liu
- Department of Clinical Pharmacy, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, PR China
| | - Xiaoyi Ma
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Aijun Shen
- Department of Medical Imaging, Tongji Hospital, Tongji University, Shanghai, 200065, PR China
| | - Yiqiong Liu
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Nopphon Weeranoppanant
- Department of Chemical Engineering, Burapha University, 169 Longhard Bangsaen, Saensook, Chonburi, 20131, Thailand
| | - Haiqing Dong
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Yan Li
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Tianbin Ren
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Le Kuai
- Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, 200092, PR China
| | - Bin Li
- Shanghai Dermatology Hospital, Tongji University School of Medicine, Shanghai, 200092, PR China.
| | - Maomao An
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China.
| | - Yongyong Li
- Shanghai Tenth People's Hospital, Department of Medical Ultrasound, Department of Pharmacology, Tongji University School of Medicine, Shanghai, 200092, PR China.
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Gessner C, Potthoff K, Frost N. Efficacy and Safety of Lipegfilgrastim in Lung Cancer Patients Receiving Myelosuppressive Chemotherapy in a Real-World Setting: Results of an Analysis of Pooled Data from Two Non-Interventional European Studies. Oncol Res Treat 2021; 44:93-102. [PMID: 33477145 DOI: 10.1159/000512594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Chemotherapy-induced neutropenia is a common and serious complication in cancer patients receiving myelosuppressive chemotherapy. This analysis was undertaken to evaluate the effectiveness and safety of prophylaxis with lipegfilgrastim, a glycoPEGylated granulocyte colony-stimulating factor, in lung cancer patients undergoing chemotherapy in real-world clinical practice. METHODS Data from two European non-interventional studies (NIS NADIR and NIS LEOS) investigating lipegfilgrastim for primary and secondary prophylaxis were pooled. Outcomes included the incidence of chemotherapy-induced neutropenia and febrile neutropenia (FN), use of anti-infectives and antimycotics, and adverse events and their relationship to lipegfilgrastim. RESULTS The safety population included 361 patients with lung cancer (median age, 66 years [range, 36-88]), of whom 322 had received 2 or more consecutive cycles of lipegfilgrastim (efficacy population [primary prophylaxis, 75.5%; secondary prophylaxis, 16.5%]). Almost 40% of the patients were considered to have a high risk (>20%) of FN, and around 60% had an intermediate risk (10-20%). For all cycles, FN was reported in 3 patients (0.9%), neutropenia in 14 (4.3%), and grade 4 neutropenia in 9 (2.8%). Anti-infectives were used in 27 patients (8.4%) and antimycotics in 6 (1.9%). The incidence rates were lower for the patients' first cycle (FN, 0.4%; neutropenia, 0.8%; grade 4 neutropenia, 0.8%; anti-infectives, 0.6%; antimycotics, 0.6%). Adverse drug reactions considered lipegfilgrastim related were reported in 35 patients (9.7%), and serious adverse drug reactions in 10 (2.8%). None of the fatal events reported in 28 patients (7.8%) were lipegfilgrastim related. CONCLUSION Lipegfilgrastim administered to patients with lung cancer undergoing chemotherapy in real-world clinical practice showed similar effectiveness and safety to that reported in published pivotal trials.
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Affiliation(s)
| | | | - Nikolaj Frost
- Department of Infectious Diseases and Pneumonology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Talwar V, Nirni SS, Mallavarapu KM, Ramkumar A, Sinha N. Safety and tolerability of Peg-grafeel ™, a pegfilgrastim, for the prophylactic treatment of chemotherapy-induced neutropenia and febrile neutropenia: A prospective, observational, postmarketing surveillance study in India. South Asian J Cancer 2020; 6:20-24. [PMID: 28413791 PMCID: PMC5379888 DOI: 10.4103/2278-330x.202560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A granulocyte colony-stimulating factor, pegfilgrastim, is efficacious though expensive for prophylactic treatment of chemotherapy-induced neutropenia and febrile neutropenia. Biologics available and accessible today, having acceptable safety-efficacy profiles, require postapproval studies for better understanding of such drugs in clinical settings. AIM This postmarketing surveillance study evaluated the safety of prophylactic Peg-grafeel™ (pegfilgrastim) in cancer patients with chemotherapy-induced neutropenia. SETTINGS AND DESIGN This prospective, noninterventional, single-arm, open-label study was conducted at 10 study sites in India. METHODS Patients received subcutaneous 6 mg Peg-grafeel™ approximately 24 h following chemotherapy as part of routine patient care. STATISTICAL ANALYSIS Data were summarized descriptively. RESULTS The study included 250 patients (male: female = 36.4%:63.6%; median age, 54 [16-80] years). Most patients had Stage III (33.2%) or IV (41.6%) cancers and received cyclophosphamide (37.2%) and doxorubicin (31.6%) as chemotherapy. On an average, 4 Peg-grafeel™ doses were administered per patient. Treatment-emergent adverse events (AEs) were reported in 115 (46%) patients, the most common being vomiting (11.6%), pain (11.2%), nausea (8.4%), and constipation (8.4%). Peg-grafeel™-related AEs included pain (3.2%), asthenia (2.4%), and arthralgia (1.2%). Bone pain (0.4%) and extremity pain (1.2%) were rare. Grade 3/4 neutropenia and febrile neutropenia occurred in 4 (1.6%) and 3 (1.2%) patients, respectively. Serious AEs included vomiting (2.8%) and pyrexia (2%). No new safety concerns were identified. None of the five deaths was considered related to Peg-grafeel™. CONCLUSION The overall safety profile of Peg-grafeel™ was consistent with the expected safety profile of pegfilgrastim in patients with advanced malignancies in a clinical setting.
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Affiliation(s)
- Vineet Talwar
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | | | - Anupama Ramkumar
- Clinical Development, Biologics, Dr. Reddy's Laboratories Ltd., Hyderabad, India
| | - Nitu Sinha
- Clinical Development, Biologics, Dr. Reddy's Laboratories Ltd., Hyderabad, India
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Link H, Illerhaus G, Martens UM, Salar A, Depenbusch R, Köhler A, Engelhardt M, Mahlmann S, Zaiss M, Lammerich A, Bias P, Buchner A. Efficacy and safety of lipegfilgrastim versus pegfilgrastim in elderly patients with aggressive B cell non-Hodgkin lymphoma (B-NHL): results of the randomized, open-label, non-inferiority AVOID neutropenia study. Support Care Cancer 2020; 29:2519-2527. [PMID: 32944800 PMCID: PMC7981320 DOI: 10.1007/s00520-020-05711-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
Background Lipegfilgrastim has been shown to be non-inferior to pegfilgrastim for reduction of the duration of severe neutropenia (DSN) in breast cancer patients. This open-label, non-inferiority study assessed the efficacy and safety of lipegfilgrastim versus pegfilgrastim in elderly patients with aggressive B cell non-Hodgkin lymphoma (NHL) at high risk for chemotherapy-induced neutropenia. Patient and methods One hundred and one patients (median age, 75 years) were randomized to lipegfilgrastim or pegfilgrastim (6 mg/cycle) during six cycles of R-CHOP21. Results Lipegfilgrastim was non-inferior to pegfilgrastim for the primary efficacy endpoint, reduction of DSN in cycle 1. In the per-protocol population, mean (standard deviation) DSN was 0.8 (0.92) and 0.9 (1.11) days in the two groups, respectively; the adjusted mean difference between groups was − 0.3 days (95% confidence interval, − 0.70 to 0.19). Non-inferiority was also demonstrated in the intent-to-treat population. The incidence of severe neutropenia in cycle 1 was 51% (21/41) in the lipegfilgrastim group and 52% (23/44) in the pegfilgrastim group. Very severe neutropenia (ANC < 0.1 × 109/L) in cycle 1 was reported by 5 (12%) patients in the lipegfilgrastim group and 8 (18%) patients in the pegfilgrastim group. However, over all cycles, febrile neutropenia (strict definition) was reported by only 1 (2%) patient in each treatment group (during cycle 1 in the lipegfilgrastim group and cycle 6 in the pegfilgrastim group). The mean time to absolute neutrophil count recovery (defined as ≥ 2.0 × 109/L) was 8.3 and 9.4 days in the two groups, respectively. Serious adverse events occurred in 46% of patients in each group; none were considered treatment-related. Eight patients died during the study (2 in the lipegfilgrastim group, 5 in the pegfilgrastim group, and 1 who died before starting study treatment). No deaths occurred during the treatment period, and all were considered to be related to the underlying disease. Conclusions This study shows lipegfilgrastim to be non-inferior to pegfilgrastim for the reduction of DSN in elderly patients with aggressive B cell NHL receiving myelosuppressive chemotherapy, with a comparable safety profile. Trial registration number ClinicalTrials.gov identifier NCT02044276; EudraCT number 2013-001284-23 Electronic supplementary material The online version of this article (10.1007/s00520-020-05711-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hartmut Link
- Private Practice Hematology Medical Oncology, Finkenhain 8, 67661, Kaiserslautern, Germany.
| | - G Illerhaus
- Hematology, Oncology and Palliative Medicine Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - U M Martens
- Hematology, Oncology and Palliative Medicine Clinic, SLK-Clinics, Heilbronn, Germany
| | - A Salar
- Hospital del Mar Paseo Marítimo, Hematology, Barcelona, Spain
| | - R Depenbusch
- Oncology Practice, Gütersloh, Gütersloh, Germany
| | - A Köhler
- Hematology and Oncology Collective Practice, Asklepios Clinic Specialist Medical Centre Langen, Langen, Germany
| | - M Engelhardt
- Internal Medicine Clinic I, Hematology, Oncology and Stem Cell Transplantation, University Clinic, Faculty of Freiburg, Freiburg, Germany
| | - S Mahlmann
- Hematology/Oncology and Nephrology Clinic, Friedrich-Ebert-Hospital Neumünster, Neumünster, Germany
| | - M Zaiss
- Interdiscliplinary Practice for Oncology and Hematology, Freiburg, Germany
| | - A Lammerich
- Teva Pharmaceuticals Industries, Ulm, Germany
| | - P Bias
- Teva Pharmaceuticals Industries, Ulm, Germany
| | - A Buchner
- Teva Pharmaceuticals Industries, Ulm, Germany
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12
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Schwartzberg LS, Bhat G, Peguero J, Agajanian R, Bharadwaj JS, Restrepo A, Hlalah O, Mehmi I, Chawla S, Hasal SJ, Yang Z, Cobb PW. Eflapegrastim, a Long-Acting Granulocyte-Colony Stimulating Factor for the Management of Chemotherapy-Induced Neutropenia: Results of a Phase III Trial. Oncologist 2020; 25:e1233-e1241. [PMID: 32476162 PMCID: PMC7418343 DOI: 10.1634/theoncologist.2020-0105] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background Eflapegrastim, a novel, long‐acting recombinant human granulocyte‐colony stimulating factor (rhG‐CSF), consists of a rhG‐CSF analog conjugated to a human IgG4 Fc fragment via a short polyethylene glycol linker. Preclinical and phase I and II pharmacodynamic and pharmacokinetic data showed increased potency for neutrophil counts for eflapegrastim versus pegfilgrastim. This open‐label phase III trial compared the efficacy and safety of eflapegrastim with pegfilgrastim for reducing the risk of chemotherapy‐induced neutropenia. Materials and Methods Patients with early‐stage breast cancer were randomized 1:1 to fixed‐dose eflapegrastim 13.2 mg (3.6 mg G‐CSF) or standard pegfilgrastim (6 mg G‐CSF) following standard docetaxel plus cyclophosphamide chemotherapy for 4 cycles. The primary objective was to demonstrate the noninferiority of eflapegrastim compared with pegfilgrastim in mean duration of severe neutropenia (DSN; grade 4) in cycle 1. Results Eligible patients were randomized 1:1 to study arms (eflapegrastim, n = 196; pegfilgrastim, n = 210). The incidence of cycle 1 severe neutropenia was 16% (n = 31) for eflapegrastim versus 24% (n = 51) for pegfilgrastim, reducing the relative risk by 35% (p = .034). The difference in mean cycle 1 DSN (−0.148 day) met the primary endpoint of noninferiority (p < .0001) and also showed statistical superiority for eflapegrastim (p = .013). Noninferiority was maintained for the duration of treatment (all cycles, p < .0001), and secondary efficacy endpoints and safety results were also comparable for study arms. Conclusion These results demonstrate noninferiority and comparable safety for eflapegrastim at a lower G‐CSF dose versus pegfilgrastim. The potential for increased potency of eflapegrastim to deliver improved clinical benefit warrants further clinical study in patients at higher risk for CIN. Implications for Practice Chemotherapy‐induced neutropenia (CIN) remains a significant clinical dilemma for oncology patients who are striving to complete their prescribed chemotherapy regimen. In a randomized, phase III trial comparing eflapegrastim to pegfilgrastim in the prevention of CIN, the efficacy of eflapegrastim was noninferior to pegfilgrastim and had comparable safety. Nevertheless, the risk of CIN remains a great concern for patients undergoing chemotherapy, as the condition frequently results in chemotherapy delays, dose reductions, and treatment discontinuations. Myelosuppression, particularly neutropenia, has presented a major challenge in cancer treatment since the introduction of cytotoxic chemotherapy. This article reports the results of a phase III trial that compared the efficacy and safety of eflapegrastim with pegfilgrastim for reducing the risk of chemotherapy‐induced neutropenia.
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Affiliation(s)
| | - Gajanan Bhat
- Spectrum Pharmaceuticals, Inc.IrvineCaliforniaUSA
| | | | - Richy Agajanian
- The Oncology Institute of Hope and InnovationDowneyCaliforniaUSA
| | | | | | | | - Inderjit Mehmi
- City of Hope Comprehensive Cancer CenterSimi ValleyCaliforniaUSA
| | | | | | - Zane Yang
- Spectrum Pharmaceuticals, Inc.IrvineCaliforniaUSA
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13
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Daniele G, Arenare L, Scambia G, Pisano C, Sorio R, Breda E, De Placido S, Savarese A, Ferrandina G, Raspagliesi F, Panici PB, Ferro A, Rimanti A, Cormio G, Lorusso D, Cecere SC, Scalone S, Marsico VA, Cardalesi C, Cognetti F, Salutari V, Attademo L, Guizzaro L, Schettino C, Piccirillo MC, Perrone F, Gallo C, Pignata S. Prognostic role of chemotherapy-induced neutropenia in first-line treatment of advanced ovarian cancer. A pooled analysis of MITO2 and MITO7 trials. Gynecol Oncol 2019; 154:83-88. [PMID: 31029508 DOI: 10.1016/j.ygyno.2019.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chemotherapy-induced neutropenia (CIN) has been associated with improved prognosis in several cancer conditions. Contrasting data have been produced in ovarian cancer.
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Affiliation(s)
- Gennaro Daniele
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
| | - Giovanni Scambia
- Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy.
| | - Carmela Pisano
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
| | - Roberto Sorio
- Oncologia B, Centro di Riferimento Oncologico, 33081 Aviano, PN, Italy.
| | - Enrico Breda
- Oncologia Medica, Ospedale S. Giovanni Calibita Fatebenefratelli, 00186 Roma, Italy
| | - Sabino De Placido
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy.
| | - Antonella Savarese
- Oncologia Medica 1, IRCCS Istituto Nazionale Tumori Regina Elena, 00144 Roma, Italy.
| | - Gabriella Ferrandina
- Ginecologia Oncologica, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | | | | | | | | | - Gennaro Cormio
- Ginecologia Oncologica, IRCCS Istituto Oncologico "Giovanni Paolo II", Bari & Department of Biomedical Sciences and Oncology, University "Aldo Moro" Bari, 70124 Bari, Italy.
| | - Domenica Lorusso
- Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
| | - Simona Scalone
- Oncologia B, Centro di Riferimento Oncologico, 33081 Aviano, PN, Italy.
| | | | - Cinzia Cardalesi
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy.
| | - Francesco Cognetti
- Oncologia Medica 1, IRCCS Istituto Nazionale Tumori Regina Elena, 00144 Roma, Italy.
| | - Vanda Salutari
- Ginecologia Oncologica, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Laura Attademo
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia
| | - Lorenzo Guizzaro
- Statistica Medica, Università della Campania Luigi Vanvitelli, 80138 Napoli, Italy
| | - Clorinda Schettino
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
| | - Ciro Gallo
- Statistica Medica, Università della Campania Luigi Vanvitelli, 80138 Napoli, Italy.
| | - Sandro Pignata
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori - IRCCS- Fondazione G.Pascale, Napoli, Italia.
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14
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Laribi K, Badinand D, Janoray P, Benabed K, Mouysset JL, Fabre E, Monchecourt F, Diab R. Filgrastim prophylaxis in elderly cancer patients in the real-life setting: a French multicenter observational study, the TULIP study. Support Care Cancer 2019; 27:4283-4292. [PMID: 30874925 PMCID: PMC6803566 DOI: 10.1007/s00520-019-04725-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 03/01/2019] [Indexed: 01/06/2023]
Abstract
Purpose Few studies are currently available among elderly patients, justifying the need for better understanding of daily medical practices in terms of use of growth factors to prevent chemotherapy (CT)-induced neutropenia. The primary objective of this study was to describe the use of filgrastim in the elderly. Methods Cancer patients aged 65 years and above, undergoing CT and initiating a prophylactic treatment with filgrastim, were enrolled. Patients were followed according to routine medical practice from filgrastim initiation until the end of the CT or after a maximum of 6 cycles. Results One thousand one hundred nineteen evaluable patients were documented in the study (mean age 73.9 ± 6.2 years, 52.1% men). The majority were suffering from solid tumor (73%) with ECOG 0–1 for 80% of them. Approximately two-third had a global risk for FN ≥ 20%, and one third < 20%. Through all CT cycles, no differences were observed between age classes ([65–74], [75–85], or > 85) in dose, duration, and time to first injection from CT start. Most patients (84%) received primary prophylaxis (PP) and 70% were administered during the first CT cycle. The median time from CT start until filgrastim was 4 days. The median duration of filgrastim treatment was 5 days. Dose reductions and CT delays were less frequent in patients receiving PP (4.8% and 7.1% respectively) than secondary prophylaxis (9.2% and 13.3% respectively). Conclusions Filgrastim use was consistent with French Market Authorization terms. No difference was shown compared with younger patients. Safety data were consistent with the known safety profile. Electronic supplementary material The online version of this article (10.1007/s00520-019-04725-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kamel Laribi
- Department of Hematology, Le Mans Hospital, Le Mans, France. .,Department of Medical Onco-Hematology, Le Mans Hospital, 194 Avenue Rubillard, 72037, Le Mans Cedex 9, France.
| | - Delphine Badinand
- Department of Radiotherapy Oncology, Hospital La Timone, Marseille, France
| | | | - Khaled Benabed
- Department of Clinical Hematology, Hospital Côte de Nacre, Caen, France.,Public Hospital Center of Cotentin, Cherbourg-en-Cotentin, France
| | - Jean-Loup Mouysset
- Department of Chemotherapy, Outpatient Unit, Polyclinic Parc Rambot Provençal, Aix-en-Provence, France
| | - Elizabeth Fabre
- Department of Medical Oncology, European Hospital Georges Pompidou, Paris, France
| | | | - Rafik Diab
- Specialized Medical Center of Praz-Coutant, Passy, France
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15
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Waller CF, Ranganna GM, Pennella EJ, Blakeley C, Bronchud MH, Mattano LA, Berzoy O, Voitko N, Shparyk Y, Lytvyn I, Rusyn A, Popov V, Láng I, Beckmann K, Sharma R, Baczkowski M, Kothekar M, Barve A. Randomized phase 3 efficacy and safety trial of proposed pegfilgrastim biosimilar MYL-1401H in the prophylactic treatment of chemotherapy-induced neutropenia. Ann Hematol 2019; 98:1217-1224. [PMID: 30824956 PMCID: PMC6469669 DOI: 10.1007/s00277-019-03639-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/10/2019] [Indexed: 12/17/2022]
Abstract
Pegfilgrastim is indicated for reducing the duration of neutropenia and incidence of febrile neutropenia in patients receiving cytotoxic chemotherapy. Here, safety and efficacy of MYL-1401H, a proposed pegfilgrastim biosimilar, were investigated as prophylaxis for chemotherapy-induced neutropenia. This was a phase 3, multicenter, randomized, double-blind, parallel-group equivalence trial of MYL-1401H vs European Union–sourced reference pegfilgrastim. Patients with newly diagnosed stage II/III breast cancer eligible to receive (neo) adjuvant chemotherapy with docetaxel/doxorubicin/cyclophosphamide every 3 weeks for 6 cycles were enrolled and randomized 2:1 to 6 mg of MYL-1401H or reference pegfilgrastim 24 h (+ 2-h window after the first 24 h) after the end of chemotherapy. The primary efficacy endpoint was the duration of severe neutropenia in cycle 1 (i.e., days with absolute neutrophil count (ANC) < 0.5 × 109/L). Mean (standard deviation (SD)) duration of severe neutropenia in MYL-1401H and reference pegfilgrastim groups was 1.2 days (0.93) and 1.2 days (1.10), respectively. The 95% CI for least squares mean difference (− 0.285, 0.298) was within the predefined equivalence range of ± 1 day. Secondary endpoints, including grade ≥ 3 neutropenia (frequency, 91% and 82% for MYL-1401H and reference pegfilgrastim, respectively), time to ANC nadir (mean (SD), 6.2 (0.98) and 6.3 (1.57) days), and duration of post-nadir recovery (mean (SD), 1.9 (0.85) and 1.7 (0.91) days) were comparable. Overall safety profiles of the study drugs were comparable. MYL-1401H demonstrated equivalent efficacy and similar safety to reference pegfilgrastim and may be an equivalent option for reducing incidence of neutropenia. (ClinicalTrials.gov, NCT02467868; EudraCT, 2014-002324-27).
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Affiliation(s)
- Cornelius F Waller
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg and Faculty of Medicine, University of Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.
| | - Gopinath M Ranganna
- Global Clinical Research & Development, Mylan, Prestige Tech Park Platina-3, 7th to 12th Floor, Kadubesanahalli, Bangalore, 560103, India
| | - Eduardo J Pennella
- Global Clinical Research, Mylan, 1000 Mylan Boulevard, Canonsburg, PA, 15317, USA
| | - Christopher Blakeley
- Medical and Scientific Affairs, Worldwide Clinical Trials, 172 Tottenham Court Road, Fitzrovia, London, W1T 7DL, UK
| | - Miguel H Bronchud
- GenesisCare Corachan Institute of Oncology, Buïgas 19, 08017, Barcelona, Spain
| | - Leonard A Mattano
- HARP Pharma Consulting, LLC, 184 Masons Island Road, Mystic, CT, 06355, USA
| | - Oleksandr Berzoy
- Mammalogy Center, Odessa Regional Hospital, Akademika Zabolotnogo Str. 26, Odessa, 65025, Ukraine
| | - Nataliia Voitko
- Chemotherapy II, Kyiv City Clinical Oncological Centre, Kyiv, Street, Verkhovyna, 69, Kiev, 03115, Ukraine
| | - Yaroslav Shparyk
- Department of Chemotherapy, Lviv State Regional Treatment and Diagnostics Oncology Center, Lviv Street, Pekarskaya, 69, Lviv, 79010, Ukraine
| | - Iryna Lytvyn
- Department of Chemotherapy, Dnipropetrovsk Regional Clinical Oncology Center, Kosmicheskaja Street, 21, Dnepropetrovsk, 49100, Ukraine
| | - Andriy Rusyn
- Department of Chemotherapy, Transkarpathian Regional University Oncology Clinic, Narodna Square, 3, Uzhgorod, 88000, Ukraine
| | - Vasil Popov
- Department of Medical Oncology and Palliative Care, SHATOD Dr. Marko Аntonov Markov, Varna EOOD, SHOP "Tsar Osvoboditel" Boulevard 100000, 9000, Varna, Bulgaria
| | - István Láng
- Department of Medical Oncology and Clinical Pharmacology B, National Institute of Oncology Országos Onkológiai Intézet, Budapest Ráth György u. 7-9, Budapest, 1122, Hungary
| | - Katrin Beckmann
- Global Clinical Operations, Mylan Healthcare GmbH, Freundallee 9A, 30173, Hannover, Germany
| | - Rajiv Sharma
- Global Product Safety and Risk Management, Mylan, Building 4 Trident Place, Mosquito Way, Hatfield, AL10 9UL, UK
| | - Mark Baczkowski
- Product Safety and Risk Management, Mylan, 781 Chestnut Ridge Road, Morgantown, WV, 26505, USA
| | - Mudgal Kothekar
- Clinical Development, Biocon Research Ltd, 131, Jigani Road, RK Twp, Bommasandra Industrial Area, Bangalore, Karnataka, 560099, India
| | - Abhijit Barve
- Global Clinical Research, Mylan, 1000 Mylan Boulevard, Canonsburg, PA, 15317, USA
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Kahan Z, Grecea D, Smakal M, Tjulandin S, Bondarenko I, Perjesi L, Illes A, Horvat-Karajz K, Aradi I. Efficacy and safety of RGB-02, a pegfilgrastim biosimilar to prevent chemotherapy-induced neutropenia: results of a randomized, double-blind phase III clinical study vs. reference pegfilgrastim in patients with breast cancer receiving chemotherapy. BMC Cancer 2019; 19:122. [PMID: 30727980 PMCID: PMC6364429 DOI: 10.1186/s12885-019-5329-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
Background Treatment with recombinant human granulocyte-colony stimulating factor (G-CSF) is accepted standard for prevention of chemotherapy-induced neutropenia. RGB-02 (Gedeon Richter) is a proposed biosimilar to pegylated G-CSF (Neulasta®, Amgen) with sustained release properties. This is a randomized, comparative, double-blind, multicenter study to evaluate efficacy and safety of RGB-02 in breast cancer patients receiving cytotoxic regimen. Methods Two hundred thirty-nine women presenting with breast cancer were randomized to RGB-02 (n = 121) and the reference product (n = 118). All patients received up to 6 cycles of docetaxel/doxorubicin chemotherapy combination and a once-per-cycle injection of a fixed 6 mg dose of pegfilgrastim. Primary endpoint was the duration of severe neutropenia (ANC < 0.5 × 109/L) in Cycle 1 (2-sided CI 95%). Secondary endpoints included incidence and duration of severe neutropenia (in cycles 2–4), incidence of febrile neutropenia, time to ANC recovery, depth of ANC nadir, and safety outcomes. Results The mean duration of severe neutropenia in Cycle 1 was 1.7 (RGB-02) and 1.6 days (reference), with a difference (LS Mean) of 0.1 days (95% CI -0.2, 0.4). Equivalence could be established as the CI for the difference in LS Mean lay entirely within the pre-defined range of ±1 day. This positive result was supported by the analysis of secondary endpoints, which also revealed no clinical meaningful differences. Safety profiles were comparable between groups. No neutralizing antibodies against pegfilgrastim were identified. Conclusions Treatment equivalence in reducing the duration of chemotherapy induced neutropenia between RGB-02 and Neulasta® could be demonstrated. Similar efficacy and safety profiles of the once-per-cycle administration of RGB-02 and the pegfilgrastim reference were demonstrated. Trial registration The trial was registered prospectively, prior to study initiation. EudraCT number (2013–003166-14). The date of registration was 12 July, 2013. Electronic supplementary material The online version of this article (10.1186/s12885-019-5329-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zsuzsanna Kahan
- Department of Oncotherapy, University of Szeged, Korányi Fasor 12, Szeged, 6720, Hungary
| | - Daniela Grecea
- Institutul Oncologic Prof. Dr. I. Chiricuta, Republicii Bulevardul 34-36, 400015, Cluj-Napoca, Romania
| | - Martin Smakal
- Nemocnice Horovice, K nemocnici 1106, 268 01, Horovice, Czech Republic
| | - Sergei Tjulandin
- Russian Cancer Research Center of the Russian Academy of Medical Sciences, Kashirskoye Shosse 24, Moscow, Russia, 115478
| | - Igor Bondarenko
- Department of Oncology and Medical Radiology, Dnipropetrovsk Medical Academy, Vernadsky str. 9, Dnipropetrovsk, 49044, Ukraine
| | - Luca Perjesi
- Gedeon Richter Plc, Budapest, Hungary; Gyömröi út 19-21, Budapest, 1103, Hungary
| | - Andras Illes
- Gedeon Richter Plc, Budapest, Hungary; Gyömröi út 19-21, Budapest, 1103, Hungary.
| | - Karoly Horvat-Karajz
- Gedeon Richter Plc, Budapest, Hungary; Gyömröi út 19-21, Budapest, 1103, Hungary
| | - Ildiko Aradi
- Gedeon Richter Plc, Budapest, Hungary; Gyömröi út 19-21, Budapest, 1103, Hungary
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Rapoport BL, Aapro M, Paesmans M, van Eeden R, Smit T, Krendyukov A, Klastersky J. Febrile neutropenia (FN) occurrence outside of clinical trials: occurrence and predictive factors in adult patients treated with chemotherapy and an expected moderate FN risk. Rationale and design of a real-world prospective, observational, multinational study. BMC Cancer 2018; 18:917. [PMID: 30249215 PMCID: PMC6154917 DOI: 10.1186/s12885-018-4838-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/19/2018] [Indexed: 11/26/2022] Open
Abstract
Background Febrile neutropenia (FN) is a common occurrence during chemotherapy. Granulocyte colony-stimulating factors (G-CSFs) can significantly reduce the risk of FN. International guidelines recommend G-CSF for patients receiving chemotherapy with FN risk of ≥20% or 10% to 20% with defined risk factors. Prophylaxis is not typically recommended for FN risk of < 10%; however, few studies have investigated FN incidence in lower-risk patients in real-world settings and tried to identify higher-risk subgroups. Methods This real-world prospective, observational, multinational study aims to estimate the rate of development of FN with a chemotherapy line expected to be associated with a 10% to 20% risk of FN. Eligible patients (> 18 years of age) will have a solid tumour or Hodgkin/non-Hodgkin lymphoma and a planned chemotherapy regimen with expected risk of FN of 10% to 20% (according to published guidelines). Patients will be observed for the duration of the chemotherapy line (first cycle administered without FN prophylaxis). Primary endpoint is incidence of FN after the first chemotherapy cycle. Secondary outcomes include: FN-associated morbidity and mortality; time to first FN occurrence; other FN risk factors and impact of FN on quality of life. A risk model using occurrence of FN as a binary outcome will be developed. Data will be stratified by age, comorbidities and other risk factors. Discussion This study will provide insight into the real FN risk for common chemotherapy regimens and predictive factors for FN, including patients generally excluded from randomised clinical trials, from which reported FN rates have been variable. This study builds on knowledge of predictive factors from other research and will provide information on patients with 10% to 20% FN risk.
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Affiliation(s)
- Bernardo Leon Rapoport
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196, South Africa. .,Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - Marianne Paesmans
- Information Management Unit, Institut Jules Bordet, Brussels, Belgium
| | - Ronwyn van Eeden
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196, South Africa
| | - Teresa Smit
- The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196, South Africa
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Desai K, Misra P, Kher S, Shah N. Clinical confirmation to demonstrate similarity for a biosimilar pegfilgrastim: a 3-way randomized equivalence study for a proposed biosimilar pegfilgrastim versus US-licensed and EU-approved reference products in breast cancer patients receiving myelosuppressive chemotherapy. Exp Hematol Oncol 2018; 7:22. [PMID: 30202638 PMCID: PMC6127997 DOI: 10.1186/s40164-018-0114-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022] Open
Abstract
Background Chemotherapy-induced neutropenia is a common result of myelosuppressive chemotherapy treatment. Infections such as febrile neutropenia (FN) are sensitive to the duration of neutropenia as well as the depth of absolute neutrophil count (ANC) at nadir. Filgrastim, a granulocyte colony stimulating factor (G-CSF), can stimulate the function of mature neutrophils. Pegfilgrastim, a long-acting form of filgrastim, has been shown to reduce FN to a greater extent compared to filgrastim. G-CSF agents have been recommended for prophylactic administration with chemotherapy. Apotex developed a proposed pegfilgrastim biosimilar. This study was conducted to confirm that no clinically meaningful efficacy or safety differences exist between Apotex’s proposed biosimilar and its reference product. Methods 589 breast cancer patients were randomized and dosed with the proposed pegfilgrastim biosimilar, US-licensed pegfilgrastim reference product, or EU-approved pegfilgrastim reference product. The primary endpoint assessed was the duration of severe neutropenia (DSN) and secondary endpoints included rate of FN and ANC nadir. Results Data showed that the mean DSN, the primary endpoint measured, was comparable across all three treatments. The As Treated arm had a 95% confidence interval within the equivalence range for the proposed pegfilgrastim biosimilar with the US-licensed and EU-approved pegfilgrastim reference products. Secondary endpoints, which included depth and peak of ANC nadir, time to ANC recovery post-nadir and rates of FN, also showed similarity between the three different treatment groups. The adverse event incidence was similar across treatment arms and there were no unexpected safety events. Conclusions Overall, these results show that the proposed pegfilgrastim biosimilar is similar to Amgen’s US-licensed and EU-approved pegfilgrastim reference products with regard to the clinical efficacy and safety endpoints assessed. Trial registration EMA: European Union Clinical Trials Register: (https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2011-002678-21) Eudract # 2011-002678-21 Registered: 01/10/2012
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Affiliation(s)
- Kalpna Desai
- Preclinical and Clinical Programs, Apobiologix, 4100 Weston Road, Toronto, ON M9L 2Y6 Canada
| | - Priya Misra
- Preclinical and Clinical Programs, Apobiologix, 4100 Weston Road, Toronto, ON M9L 2Y6 Canada
| | - Sanyukta Kher
- Regulatory Affairs, Apobiologix, 4100 Weston Road, Toronto, ON M9L 2Y6 Canada
| | - Nirmesh Shah
- Medical Affairs, Apobiologix, 2400 N. Commerce Parkway, Suite 300, Weston, FL 33326 USA
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Bokemeyer C, Gascón P, Aapro M, Ludwig H, Boccadoro M, Denhaerynck K, Gorray M, Krendyukov A, Abraham I, MacDonald K. Over- and under-prophylaxis for chemotherapy-induced (febrile) neutropenia relative to evidence-based guidelines is associated with differences in outcomes: findings from the MONITOR-GCSF study. Support Care Cancer 2017; 25:1819-1828. [PMID: 28111718 PMCID: PMC5403842 DOI: 10.1007/s00520-017-3572-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE In the MONITOR-GCSF study of chemotherapy-induced (febrile) neutropenia with biosimilar filgrastim, 56.6% of patients were prophylacted according to amended EORTC guidelines, but 17.4% were prophylacted below and 26.0% above guideline recommendations. METHODS MONITOR-GCSF is a prospective, observational study of 1447 evaluable patients from 140 cancers centers in 12 European countries treated with myelosuppressive chemotherapy for up to 6 cycles receiving biosimilar GCSF prophylaxis. Patients were classified as under-, correctly-, or over-prophylacted with GCSF relative to guideline recommendations based on their chemotherapy risk, individual risk factors, and type of GCSF prophylaxis (primary versus secondary). RESULTS Differences between under- (17.4%), correctly- (56.6%), or over-prophylacted (26.0%) groups were found in terms of patient risk factors (age, performance status, history of FN, comorbid conditions) as well as prophylaxis patterns (type of prophylaxis, day of GCSF initiation, and GCSF duration). Rates of chemotherapy-induced neutropenia (CIN) (all grades), FN, and CIN-related hospitalizations were consistently lower in over-prophylacted patients relative to under- and correctly-prophylacted patients. No differences were observed between under- and correctly-prophylacted patients except for CIN/FN-related chemotherapy disturbances. No GCSF safety differences were found between groups (except for headaches). CONCLUSIONS The real-world evidence provided by the MONITOR-GCSF study indicates that providing GCSF support may yield better CIN, FN, and CIN/FN-related hospitalization outcomes if patients are prophylacted at levels above guideline recommendations. Patients who are under-prophylacted are at higher risk for disturbances to their chemotherapy regimens. Our findings support the guideline recommendation that CIN/FN risk be assessed at the beginning of each chemotherapy cycle.
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Affiliation(s)
| | - Pere Gascón
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - Heinz Ludwig
- Medizinische Abteilung I - Onkologie und Haematologie, Wilhelminenspital, Wien, Austria
| | - Mario Boccadoro
- Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy
| | - Kris Denhaerynck
- Matrix45, 6159 W Sunset Rd, Tucson, AZ, 85743, USA
- Universitaet Basel, Basel, Switzerland
| | | | | | - Ivo Abraham
- Matrix45, 6159 W Sunset Rd, Tucson, AZ, 85743, USA.
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.
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Otake A, Tsuji D, Taku K, Kawasaki Y, Yokoi M, Nakamori H, Osada M, Matsumoto M, Inoue K, Hirai K, Itoh K. Chemotherapy-induced neutropenia as a prognostic factor in patients with metastatic pancreatic cancer treated with gemcitabine. Eur J Clin Pharmacol 2017; 73:1033-9. [PMID: 28487999 DOI: 10.1007/s00228-017-2260-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/24/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Chemotherapy-induced neutropenia (CIN) is a common side effect of chemotherapy and an important dose-limiting factor. However, an association between CIN development and longer survival was recently reported in several solid cancers. In the present study, we aimed to assess whether CIN could be a prognostic factor and clarify other prognostic factors for patients with metastatic pancreatic cancer. METHODS We retrospectively analyzed the medical records of 84 patients who received gemcitabine monotherapy as first-line chemotherapy for metastatic pancreatic cancer to assess whether CIN could be a prognostic factor. Potential prognostic factors of survival were examined by univariate and multivariate analyses using the log-rank test and Cox proportional hazard model, respectively. RESULTS Median survival time was 170 days [95% confidence interval (CI), 147-193] in patients without CIN (grade 0), 301 days (95% CI, 152-450) in patients with grade 1-2 CIN, and 406 days (95% CI, 271-541) in patients with grade 3 CIN. The multivariate analysis revealed that a pretreatment C-reactive protein level of <0.50 mg/dL [hazard ratio (HR), 0.534; 95% CI, 0.323-0.758, P = 0.015] and grade 3 CIN (HR, 0.447; 95% CI, 0.228-0.875, P = 0.019) were independent favorable prognostic factors in patients with metastatic pancreatic cancer treated with gemcitabine. CONCLUSIONS Neutropenia during chemotherapy was associated with increased survival of patients with metastatic pancreatic cancer. Monitoring of CIN could be used to predict treatment responsiveness.
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Sbrana A, Torchio M, Comolli G, Antonuzzo A, Danova M. Use of procalcitonin in clinical oncology: a literature review. New Microbiol 2016; 39:174-180. [PMID: 27284982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 06/06/2023]
Abstract
The use of procalcitonin (PCT) as an early marker of infectious episodes in cancer patients is still controversial. We performed a MEDLINE search of peer-reviewed articles published between January 1990 and December 2015, and finally we analysed 15 articles. PCT seems to have a good diagnostic value of infectious episodes in cancer patients and its accuracy seems greater if we consider major events, such as bloodstream infections and sepsis. Serial evaluations of this protein seem to be more accurate in the diagnostic phase and useful to predict outcome and response to antibacterial treatment. On the other hand, some issues have yet to be solved, such as the use of a validated method of determination, the definition of a standard cut-off, and the heterogeneity among different settings of patients (e.g. early versus advanced-stage cancer, or haematological versus solid tumours). However, it is credible to think that PCT use in everyday clinical practice, preferably in combination with other clinical or laboratory tests, might be of help in finding and detecting early infectious complications in cancer patients.
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Affiliation(s)
- Andrea Sbrana
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Martina Torchio
- Medicina Interna e Oncologia, Ospedale Civile di Vigevano, ASST Pavia, Italy
| | - Giuditta Comolli
- Laboratori di Ricerca Biotecnologie e S.C. Microbiologia e Virologia, Fondazione IRCSS Policlinico San Matteo, Pavia, Italy
| | - Andrea Antonuzzo
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Danova
- Medicina Interna e Oncologia, Ospedale Civile di Vigevano, ASST Pavia, Italy
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Nahon S, Rastkhah M, Ben Abdelghani M, Soumoudronga RF, Gasnereau I, Labourey JL. Zarzio®, biosimilar of filgrastim, in prophylaxis of chemotherapy-induced neutropenia in routine practice: a French prospective multicentric study. Support Care Cancer 2016; 24:1991-1998. [PMID: 26507190 PMCID: PMC4805722 DOI: 10.1007/s00520-015-2986-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/09/2015] [Indexed: 10/25/2022]
Abstract
PURPOSE Chemotherapy-induced neutropenia is a serious and potentially life-threatening consequence of cancer treatment. Prophylactic treatment with granulocyte-colony stimulating factor (G-CSF) decreases the incidence of febrile neutropenia, the rate of hospitalization, and the use of antibiotics in patients at risk. The aim of this study was to assess efficacy, safety, and use of Zarzio(®)-biosimilar of Neupogen(®) (G-CSF; filgrastim)-in prophylaxis of chemotherapy-induced neutropenia in current practice in cancer patients. METHODS We conducted an observational, prospective, longitudinal, and multicentric study in France. The incidence of neutropenia was evaluated at each cycle of chemotherapy. RESULTS One hundred eighty-four patients (women, 64.7 %; mean age, 61.7 years) with solid tumor (89.7 %; breast cancer, 50.5 %) or non-Hodgkin lymphoma (10.3 %) were included. The risk of febrile neutropenia based on chemotherapy regimen was >20 % for 32.1 % of patients. No case of febrile neutropenia was reported. Neutropenia was the cause of hospitalization and/or antibiotic therapy in 10 patients. The most frequent adverse events related to Zarzio(®) were pain, in particular bone pain. No serious adverse event related to Zarzio(®) was reported. CONCLUSION The results obtained in real-life conditions confirm that Zarzio(®) is efficient and well tolerated in cancer patients.
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Affiliation(s)
- Sophie Nahon
- Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | | | | | | | - Isabelle Gasnereau
- Sandoz Biopharmaceuticals, 49, Avenue Georges Pompidou, 92593, Levallois-Perret, Cedex, France.
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Li Y, Klippel Z, Shih X, Wang H, Reiner M, Page JH. Trajectory of absolute neutrophil counts in patients treated with pegfilgrastim on the day of chemotherapy versus the day after chemotherapy. Cancer Chemother Pharmacol 2016; 77:703-12. [PMID: 26886017 PMCID: PMC4819939 DOI: 10.1007/s00280-016-2970-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/13/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Risk of infection increases with severity and duration of chemotherapy-induced neutropenia (CIN). Pegfilgrastim is approved for use on the day after chemotherapy to reduce incidence of infection, as manifested by febrile neutropenia (FN), in patients receiving myelosuppressive chemotherapy. In this study, we compared severity and duration of absolute neutrophil count (ANC) suppression in patients who received pegfilgrastim on the same day as chemotherapy versus the next day. METHODS We combined individual patient data from four Amgen-sponsored clinical trials in which patients with cancer were randomized to receive pegfilgrastim either the same day as chemotherapy or the next day. Severity and duration of ANC suppression were calculated using area over the curve (AOC, the area over the ANC-time response curve and below a given clinical threshold). AOC of ANC and incidences of CIN and FN were compared by day of pegfilgrastim use. RESULTS The analysis included 95 same-day patients and 97 next-day patients. Despite similar ANC at baseline, ANC at nadir was higher among next-day patients than same-day patients. Mean AOC of ANC (cutoff 0.5 × 10(9)/L) among next-day patients was lower by 0.30 (95 % confidence interval: 0.16, 0.43) 10(9)/L × day than same-day patients in cycle 1. Next-day patients had lower incidences of CIN than same-day patients, but there were no significant differences in incidences of FN. CONCLUSIONS Patients who received pegfilgrastim the day after chemotherapy had less severe and shorter suppression of ANC than patients who received pegfilgrastim the same day as chemotherapy.
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Affiliation(s)
- Yanli Li
- Center for Observational Research, Amgen Inc., 1150 Veterans Blvd, South San Francisco, CA 94080, USA.
| | - Zandra Klippel
- Clinical Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Hong Wang
- TechData Service Company, LLC, King of Prussia, PA, USA
| | - Maureen Reiner
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | - John H Page
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
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Petru E, Singer CF, Polterauer S, Galid A, Schauer C, Klocker J, Seifert M, Reinthaller A, Benedicic C, Hubalek M, Hefler L, Marth C, Scholl-Firon T, Bogner G, Zeimet AG. Prophylactic long-acting granulocyte-colony stimulating factors (G-CSF) in gynecologic malignancies: an oncologic expert statement. Wien Med Wochenschr 2015; 165:387-94. [PMID: 26471371 DOI: 10.1007/s10354-015-0392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/01/2022]
Abstract
We reviewed the status of the use of the prophylactic long-acting granulocyte colony-stimulating factors (G-CSFs) pegfilgrastim and lipegfilgrastim in gynecologic malignancies. Long-acting G-CSFs should not be used in weekly regimens. Filgrastim is not indicated in patients with febrile and/or severe neutropenia after administration of long-acting G-CSF in the same cycle. One study has shown a moderate effect on febrile neutropenia of ciprofloxacin when co-administered with pegfilgrastim. There is broad evidence from meta-analyses that pegfilgrastim effectively reduces severe neutropenia. In parallel, its adverse effects have been studied extensively. All-cause mortality was significantly reduced by pegfilgrastim. The glycopegylated long-acting G-CSF, lipegfilgrastim has demonstrated antineutropenic efficacy similar to that of pegfilgrastimin in one breast cancer study. In another pivitol non-small cell lung cancer study, impaired survival was observed in the lipegfilgrastim group during the first 30 days of study. The European Medicines Agency claimed more profound safety data to be provided for lipegfilgrastim by 2017.
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Affiliation(s)
- Edgar Petru
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Arik Galid
- Department of Obstetrics and Gynecology, Hanuschkrankenhaus, Vienna, Austria
| | - Christian Schauer
- Department of Gynecology, Hospital Barmherzige Brüder Graz, Graz, Austria
| | - Johann Klocker
- Department of Internal Medicine, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Alexander Reinthaller
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christoph Benedicic
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Hefler
- Department of Gynecology, Hospital Barmherzige Schwestern, Linz, Austria
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tonja Scholl-Firon
- Department of Obstetrics and Gynecology, Wilhelminenspital, Vienna, Austria
| | - Gerhard Bogner
- Department of Obstetrics and Gynecology, Paracelsus University of Salzburg, Salzburg, Austria
| | - Alain-Gustave Zeimet
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
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Lee KH, Kim JY, Lee MH, Han HS, Lim JH, Park KU, Park IH, Cho EK, Yoon SY, Kim JH, Choi IS, Park JH, Choi YJ, Kim HJ, Jung KH, Kim SY, Oh DY, Im SA. A randomized, multicenter, phase II/III study to determine the optimal dose and to evaluate the efficacy and safety of pegteograstim (GCPGC) on chemotherapy-induced neutropenia compared to pegfilgrastim in breast cancer patients: KCSG PC10-09. Support Care Cancer 2016; 24:1709-17. [PMID: 26423618 DOI: 10.1007/s00520-015-2963-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/21/2015] [Indexed: 10/26/2022]
Abstract
PURPOSE Pegylated granulocyte-colony-stimulating factor (G-CSF) is frequently used to prevent febrile neutropenia (FN) in patients undergoing chemotherapy with a high risk of myelosuppression. This phase II/III study was conducted to determine the adequate dose of pegteograstim, a new formulation of pegylated G-CSF, and to evaluate the efficacy and safety of pegteograstim compared to pegfilgrastim. METHODS In the phase II part, 60 breast cancer patients who were undergoing DA (docetaxel and doxorubicin) or TAC (docetaxel, doxorubicin, and cyclophosphamide) chemotherapy were randomly selected to receive a single subcutaneous injection of 3.6 or 6.0 mg pegteograstim on day 2 of each chemotherapy cycle. The phase III part was seamlessly started to compare the dose of pegteograstim at selected in phase II with 6.0 mg pegfilgrastim in 117 breast cancer patients. The primary endpoint of both the phase II and III parts was the duration of grade 4 neutropenia in the chemotherapy cycle 1. RESULTS The mean duration of grade 4 neutropenia for the 3.6 mg pegteograstim (n = 33) was similar to that for the 6.0 mg pegteograstim (n = 26) (1.97 ± 1.79 days vs. 1.54 ± 0.95 days, p = 0.33). The 6.0 mg pegteograstim was selected to be compared with the 6.0 mg pegfilgrastim in the phase III part. In the phase III part, the primary analysis revealed that the efficacy of pegteograstim (n = 56) was non-inferior to that of pegfilgrastim (n = 59) [duration of grade 4 neutropenia, 1.64 ± 1.18 days vs. 1.80 ± 1.05 days; difference, -0.15 ± 1.11 (p = 0.36, 97.5 % confidence intervals = 0.57 and 0.26)]. The time to the absolute neutrophil count (ANC) recovery of pegteograstim (≥2000/μL) was significantly shorter than that of pegfilgrastim (8.85 ± 1.45 days vs. 9.83 ± 1.20 days, p < 0.0001). Other secondary endpoints showed no significant difference between the two groups. The safety profiles of the two groups did not differ significantly. CONCLUSIONS Pegteograstim was shown to be as effective as pegfilgrastim in the reduction of chemotherapy-induced neutropenia in the breast cancer patients who were undergoing chemotherapy with a high risk of myelosuppression.
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Oh D, Kim MH, Song TJ, Cho CJ, Nam K, Cho MK, Chun JH, Jung K, Kim KP, Kim JW. 1-Pamitoyl-2-Linoleoyl-3-Acetyl-rac-Glycerol May Reduce Incidence of Gemcitabine-Induced Neutropenia: A Pilot Case-Controlled Study. World J Oncol 2015; 6:410-415. [PMID: 28983339 PMCID: PMC5624689 DOI: 10.14740/wjon937e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chemotherapy-induced neutropenia (CIN) may compromise planned chemotherapy, resulting in severe infection, dose reduction or delayed treatment. Orally administered 1-pamitoyl-2-linoleoyl-3-acetyl-rac-glycerol (PLAG) is a synthetic monoacetyldiglyceride, a product found in the antlers of sika deer. The aim of this study was to evaluate the effectiveness of PLAG for the prevention of CIN. METHODS A total of 48 patients with unresectable pancreatic cancer received gemcitabine-based palliative chemotherapy. Among those patients, 16 patients received PLAG (500 mg) twice daily from the start of chemotherapy to the completion. RESULTS The PLAG group showed a significantly lower incidence of neutropenia (absolute neutrophil count < 1,500 cells/mm3, grade 2-4), as compared to the control group (37.5% vs. 81.3%, P < 0.05). The absolute neutrophil counts (ANCs) of the PLAG group significantly less decreased from the baseline level compared to those of the control group (P < 0.05) and this significant difference in the reduction percentage of ANCs between the two groups was sustained throughout the courses of chemotherapy. No adverse events related to PLAG were observed. CONCLUSIONS PLAG was shown to be clinically effective and safe in reducing the incidence of CIN in pancreatic cancer patients receiving gemcitabine-based chemotherapy.
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Affiliation(s)
- Dongwook Oh
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myung-Hwan Kim
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Charles J Cho
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kwangwoo Nam
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min Keun Cho
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Hyun Chun
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoungwon Jung
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyu-Pyo Kim
- Division of Oncology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Wha Kim
- Biomedical Translational Research Center, Korea Research Institute of Bioscience and Biotechnology, Deajeon, Korea
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Tewari KS, Java JJ, Gatcliffe TA, Bookman MA, Monk BJ. Chemotherapy-induced neutropenia as a biomarker of survival in advanced ovarian carcinoma: an exploratory study of the gynecologic oncology group. Gynecol Oncol 2014; 133:439-45. [PMID: 24657300 DOI: 10.1016/j.ygyno.2014.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether chemotherapy-induced neutropenia (C-iN) is associated with improved survival in a population of primary advanced ovarian cancer and peritoneal carcinoma patients treated with a carboplatin plus paclitaxel chemotherapy backbone. METHODS A post-hoc exploratory analysis of Gynecologic Oncology Group (GOG) protocol 182 was performed. Landmark analysis was conducted on all patients with progression-free survival >18weeks from the time of study entry. Neutropenia was defined as the absolute neutrophil count <1000mm(3). The occurrence of C-iN was analyzed according to demographic, clinicopathologic, and therapeutic intent, including age, body surface area, and treatment arm. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate independent prognostic factors and to estimate their effects on PFS and OS. RESULTS Neutropenic data was available for 3447 patients. Neutropenic (n=3196) and non-neutropenic groups (n=251) were similar in demographic and clinicopathologic characteristics. Neutropenic patients experienced significantly improved survival compared to non-neutropenic patients with the adjusted hazard ratio (HR) for death being 0.86 (95% confidence interval 0.74-0.99; p=0.041). There was no survival benefit associated with any of the treatment arms among patients with C-iN. CONCLUSION These data suggest that C-iN may represent a clinical biomarker associated with a survival advantage for patients with untreated advanced ovarian cancer. The absence of C-iN may indicate under-dosing and ultimately attenuated anti-neoplastic effect in vulnerable populations.
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Affiliation(s)
- Krishnansu S Tewari
- Dept. of Obstetrics & Gynecology, University of California, Irvine Medical Center, Orange, CA 92868, USA.
| | - James J Java
- Gynecologic Oncology Group Statistical & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Troy A Gatcliffe
- Dept. of Obstetrics & Gynecology, GYN Oncology of Miami, Miami, FL 33176, USA
| | - Michael A Bookman
- Division of Hematology-Oncology, University of Arizona Cancer Center, Tucson, AZ 85724, USA
| | - Bradley J Monk
- Dept. of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Arizona Cancer Center, Creighton University School of Medicine, St. Joseph's Hospital & Medical Center, Phoenix, AZ 85013, USA
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