Pegfilgrastim prevents febrile neutropenia during breast cancer chemotherapy

Treatment with pegfilgrastim significantly reduces the development of chemotherapy-related febrile neutropenia in breast cancer patients, according to a recent report.

The doses for many myelosuppressive chemotherapy regimens are limited by febrile neutropenia, the authors explain in the February 20th Journal of Clinical Oncology. Previous studies have demonstrated that pegfilgrastim can reduce the incidence of febrile neutropenia associated with these regimens. Dr. Charles L. Vogel from Cancer Research Networks, Inc., in Plantation, Florida and colleagues investigated whether treatment with pegfilgrastim (Neulasta; Amgen Inc.) could reduce the rate of febrile neutropenia below the 10% to 20% usually associated with the first and subsequent cycle of docetaxel-based myelosuppressive chemotherapy in 928 women with breast cancer. The incidence of febrile neutropenia for all chemotherapy cycles was significantly lower among patients treated with pegfilgrastim (1%) than among patients that received placebo (17%), the investigators report. In fact, the report indicates, the incidence of febrile neutropenia was lower in the pegfilgrastim group for all four cycles of chemotherapy. Pegfilgrastim treatment was also associated with a lower rate of hospitalization for febrile neutropenia and a lower incidence of use of intravenous anti-infective drugs for treatment of febrile neutropenia, the researchers note. Pegfilgrastim and placebo groups did not differ in the percentage of patients who received their planned chemotherapy doses on time, the results indicate, and the adverse events typical of breast cancer patients treated with docetaxel occurred in similar percentages of patients in each group. Bone pain, a recognized side effect of pegfilgrastim treatment, occurred in a similar percentage of pegfilgrastim (31%) and placebo (27%) patients, the investigators report. “Early intervention with pegfilgrastim prevents febrile neutropenia by 94% and further prevents hospitalizations and use of intravenous anti-infectives by 80%,” the team concludes. “The use of pegfilgrastim with chemotherapy regimens with a moderate rate of febrile neutropenia, such as standard-dose docetaxel and combination docetaxel, doxorubicin, and cyclophosphamide chemotherapy, is warranted.” “Patients with a 15-20% febrile neutropenia rate on whatever regimen should get first-cycle pegfilgrastim,” Dr. Vogel told Reuters Health. “Pegfilgrastim is also required for all three node-positive breast cancer adjuvant regimens.” Dr. Vogel also suggested considering pegfilgrastim treatment during “weekly therapies where you are having trouble with getting in doses on time, e.g., vinorelbine.” (Source: J Clin Oncol 2005;23:1178-1184: Reuters Health: Will Boggs, MD: Oncolink: March 2005.)