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Use of pegfilgrastim primary prophylaxis and risk of infection, by chemotherapy cycle and regimen, among patients with breast cancer or non-Hodgkin’s lymphoma

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Abstract

Purpose

This study aims to examine granulocyte colony-stimulating factor (G-CSF) prophylaxis by cancer type, chemotherapy regimen, and cycle in a real-world setting to assess if practice conforms to clinical guidelines, which recommend G-CSF prophylaxis every cycle when a patient’s risk of febrile neutropenia (FN) is 20 % or greater, and to describe the incidence of FN among patients who discontinue pegfilgrastim (peg) prophylaxis.

Methods

The cohort was selected from administrative claims data and includes adults diagnosed with non-Hodgkin’s lymphoma (NHL) or breast cancer (BC) who began chemotherapy 2005–2010.

Results

About 83.2 % of the 4,470 patients with BC treated with dose-dense doxorubicin, cyclophosphamide (ddAC), 83.6 % of 2,197 patients with BC treated with docetaxel, doxorubicin, cyclophosphamide (TAC), and about 55.6 % of the 2,722 patients with NHL treated with cyclophosphamide, doxorubicin, vincristine, with or without prednisone for 3-week cycles (CHOP-R Q3W) received peg prophylaxis in cycle 1. Among patients on these regimens who received peg prophylaxis in cycle 1 and were still on the regimen in cycle 4, about 90 % received peg prophylaxis in that cycle. Among patients with BC or NHL who discontinued G-CSF, the incidence proportion of infection or FN varied by regimen and cycle, with a range from 0 to 14 %.

Conclusions

Despite clinical guidelines recommending G-CSF prophylaxis with chemotherapy regimens with a high risk of FN, many NHL and BC patients do not receive FN prophylaxis in cycle 1. However, among patients who receive G-CSF in cycle 1 and remain on the regimen, the majority appear to continue prophylaxis as indicated.

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Acknowledgments

We thank Dr. Xiaoyan Li and Dr. Hairong Xu (Amgen Inc., Thousand Oaks, CA, USA) and Dr. Derek Weycker and Dr. Alex Kartashov (Policy Analysis Inc., Brookline, MA, USA), who assisted with diagnosis and drug codes and other aspects of data programming, and Jan Lethen, Lori Cyprien, Vincent Jones, and Jason Yuan (Amgen Inc., Thousand Oaks, CA, USA) who provided independent review of the computer programming.

Conflict of interest

All authors are employed by Amgen Inc., Thousand Oaks, CA, USA, which sponsored this research. The authors had full control of the dataset.

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Authors and Affiliations

  1. Amgen, Inc., Thousand Oaks, CA, USA

    Wendy J. Langeberg, Conchitina C. Siozon, John H. Page, P. K. Morrow & Victoria M. Chia

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  1. Wendy J. Langeberg
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  2. Conchitina C. Siozon
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Correspondence to Wendy J. Langeberg.

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Langeberg, W.J., Siozon, C.C., Page, J.H. et al. Use of pegfilgrastim primary prophylaxis and risk of infection, by chemotherapy cycle and regimen, among patients with breast cancer or non-Hodgkin’s lymphoma. Support Care Cancer 22, 2167–2175 (2014). https://doi.org/10.1007/s00520-014-2184-5

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