The use of Neulasta® (pegfilgrastim) after the first cycle of chemotherapy among elderly patients undergoing chemotherapy decreases febrile neutropenia and associated effects compared with its use later during treatment with chemotherapy. These results were recently published in the journal Oncologist.
Chemotherapy remains the cornerstone of treatment for patients with cancer. Unfortunately, chemotherapy is associated with side effects, including 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. Among patients with neutropenia accompanied by fever (febrile neutropenia [FN]), even the slightest infection can become life-threatening. Patients with FN typically must 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, which are given by injection during chemotherapy cycles. Neulasta has the ability to reduce infections, hospitalizations, medical cost, dose delays, and death associated with infection in neutropenic patients. The FDA has approved Neulasta to be given 14 days before initiation of chemotherapy or at least 24 hours following initiation of chemotherapy. Researchers continue to evaluate the effects of Neulasta among patients who are at risk for FN.
One under-evaluated population in clinical trials evaluating Neulasta has been the elderly (65 years or older). Results from trials tend to be for patients under the age of 65; however, the majority of cancers occur in elderly patients. Importantly, elderly patients are also considered to be at a higher risk of developing neutropenia than their younger counterparts.
Researchers from the H. Lee Moffitt Cancer Center recently conducted a clinical trial including 852 elderly patients undergoing chemotherapy for either solid tumors (cancers not originating from the blood or lymph system) or non-Hodgkin’s lymphoma (NHL). Patients were divided into two groups: one group received Neulasta following their first cycle of chemotherapy (proactive use), while the other group received Neulasta at the discretion of their physician (reactive treatment).
- The incidence of FN was significantly lower among patients in the proactive group compared with those in the reactive group.
- Hospitalizations for FN or neutropenia were reduced by half among the proactive versus reactive groups.
- Among patients with solid tumors, antibiotic use was reduced among the proactive versus reactive groups.
The researchers concluded: “[Neulasta] should be used proactively in elderly cancer patients to support the optimal delivery of standard chemotherapy.” Elderly patients undergoing chemotherapy may wish to speak with their physician regarding their individual risks and benefits of receiving proactive Neulasta.
Reference: Balducci L, Al-Halawario H, Charu V, et al. Elderly cancer patients receiving chemotherapy benefit from first-cycle pegfilgrastim. Oncologist. 2007;12:1416-1424.
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