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Multicenter Study
. 2013 May;22(3):400-12.
doi: 10.1111/ecc.12043. Epub 2013 Jan 18.

Effectiveness of daily versus non-daily granulocyte colony-stimulating factors in patients with solid tumours undergoing chemotherapy: a multivariate analysis of data from current practice

D Almenar Cubells  1 , C Bosch Roig, E Jiménez Orozco, R Álvarez, J M Cuervo, N Díaz Fernández, A B Sánchez Heras, A Galán Brotons, V Giner Marco, M Codes M De Villena; LEARN II Study Group
Collaborators, Affiliations
Free PMC article
Multicenter Study

Effectiveness of daily versus non-daily granulocyte colony-stimulating factors in patients with solid tumours undergoing chemotherapy: a multivariate analysis of data from current practice

D Almenar Cubells et al. Eur J Cancer Care (Engl). 2013 May.
Free PMC article

Abstract

We conducted a multicentre, retrospective, observational study including patients with solid tumours (excluding breast cancer) that received granulocyte colony-stimulating factors (G-CSF) and chemotherapy. We investigated the effectiveness of daily vs. non-daily G-CSFs (pegfilgrastim) adjusting by potential confounders. The study included 391 patients (211 daily G-CSF; 180 pegfilgrastim), from whom 47.3% received primary prophylaxis (PP) (57.8% pegfilgrastim), 26.3% secondary prophylaxis (SP: initiation after cycle 1 and no reactive treatment in any cycle) (51.5% pegfilgrastim) and 26.3% reactive treatment (19.4% pegfilgrastim). Only 42.2% of patients with daily G-CSF and 46.2% with pegfilgrastim initiated prophylaxis within 72 h after chemotherapy, and only 10.5% of patients with daily G-CSF received it for ≥ 7 days. In the multivariate models, daily G-CSF was associated with higher risk of grade 3-4 neutropenia (G3-4N) vs. pegfilgrastim [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.004-2.97]. Relative to SP, PP protected against G3-4N (OR for SP vs. PP: 6.0, 95%CI: 3.2-11.4) and febrile neutropenia (OR: 3.1, 95%CI: 1.1-8.8), and was associated to less chemotherapy dose delays and reductions (OR for relative dose intensity <85% for SP vs. PP: 3.1, 95%CI: 1.7-5.4) and higher response rate (OR: 2.1, 95%CI: 1.2-3.7). Data suggest that pegfilgrastim, compared with a daily G-CSF, and PP, compared with SP, could be more effective in preventing neutropenia and its related events in the clinical practice.

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Figures

Figure 1
Figure 1
Study scheme. G-CSF, granulocyte colony-stimulating factors.
Figure 2
Figure 2
Patterns of use of G-CSF treatment in the study sample. formula image, Pegfilgrastim; formula image, Daily G-CSF. G-CSF, granulocyte colony-stimulating factors.
Figure 3
Figure 3
Incidence of severe neutropenia and febrile neutropenia in subgroups of patients receiving: (a) daily G-CSF or pegfilgrastim. formula image, Daily G-CSF; formula image, Pegfilgrastim. (b) daily G-CSF (<5 days or ≥5 days) or pegfilgrastim. formula image, Daily G-CSF (<5 days); formula image, Daily G-CSF (≥5 days); formula image, Pegfilgrastim. G-CSF, granulocyte colony-stimulating factors.
See this image and copyright information in PMC

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