Neulasta® on First Day of Chemotherapy May Be More Convenient for Gynecologic Cancers

The administration of the blood cell growth factor Neulasta® (pegfilgrastim) on the first day of chemotherapy among women with gynecologic cancers may be as effective as and more convenient than second-day administration. These results were recently reported at the 2008 annual Society of Gynecologic Oncologists meeting.

Gynecologic cancers include cancers involving the organs or tissues of the female reproductive system. Cancers of the uterus, cervix, ovary, fallopian tubes, and/or vulva are all considered gynecologic cancers. Often, treatment for gynecologic cancers includes chemotherapy. Unfortunately, chemotherapy is associated with side effects, such as low levels of immune cells-a condition referred to as neutropenia. Patients with neutropenia can become susceptible to infection with bacteria, viruses, and/or fungus; even the slightest infection can become life-threatening. Patients with neutropenia must often have their treatment doses delayed or reduced, which decreases chances for the best outcomes.

Fortunately, neutropenic patients can receive blood cell boosters (growth factors) such as Neulasta or Neupogen® (filgrastim), which are given by injection during chemotherapy cycles. Neulasta and Neupogen have demonstrated the ability to reduce infections, hospitalizations, medical cost, dose delays, and death associated with infection in neutropenic patients. The FDA has approved Neulasta (a longer-acting form of Neupogen) to be given 14 days before initiation of chemotherapy or at least 24 hours following initiation of chemotherapy (however, this requires patients to return to the medical office or hospital one day following chemotherapy for administration).

Researchers from the University of Alabama recently reviewed data to evaluate the use of Neulasta on the first day of chemotherapy among women with gynecologic cancers. This study included 230 women who had received Neulasta on the first day of their chemotherapy and 139 patients who received Neulasta on the second day of their chemotherapy. Approximately 66% of patients had ovarian cancer, and approximately 40% were being treated for recurrent cancer.

  • Rates of severe neutropenia were not significantly different among the patients treated with Neulasta on the first day or second day of chemotherapy.
  • Treatment dose reduction or delay was not significantly different between patients treated with Neulasta on the first day or second day of chemotherapy.

The researchers concluded that Neulasta administered among women with gynecologic cancers on the first day of chemotherapy appears just as effective as Neulasta administered on the second day of chemotherapy in terms of severe neutropenia or treatment modification. Administration of Neulasta on the first day of chemotherapy may provide added convenience to patients; however, the FDA has not yet approved this indication.

Reference: Whitworth J, et al. The safety and efficacy of day 1 versus day 2 administration of pegfilgrastim in patients receiving myelosuppressive chemotherapy for gynecologic malignancies. Proceedings from the 2008 annual meeting of the Gynecologic Oncologists. Abstract #68.

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