Risk of chemotherapy-induced febrile neutropenia with early discontinuation of pegfilgrastim prophylaxis in US clinical practice.

Content Provider	Europe PMC
Author	Weycker, Derek Li, Xiaoyan Barron, Rich Li, Yanli Reiner, Maureen Kartashov, Alex Figueredo, Jacqueline Tzivelekis, Spiros Garcia, Jacob
Abstract	PurposeAccumulating evidence suggests that not all cancer chemotherapy patients who receive first-cycle pegfilgrastim prophylaxis continue to receive it in subsequent cycles and that these patients may be subsequently at higher risk of febrile neutropenia (FN). Additional evidence from US clinical practice is warranted.MethodsData from two US private healthcare claims repositories were employed. The source population comprised adults who received “intermediate-risk” or “high-risk” chemotherapy regimens for solid cancers or non-Hodgkin’s lymphoma and first-cycle pegfilgrastim prophylaxis. From the source population, all patients who did not receive second-cycle pegfilgrastim prophylaxis ("comparison patients”) were matched (1:1) to those who received it (“pegfilgrastim patients”) based on cancer, regimen, and propensity score. Odds ratios (OR) for FN—broad and narrow definitions—during the second chemotherapy cycle were estimated for comparison patients versus pegfilgrastim patients using generalized estimating equations.ResultsA total of 2245 comparison patients (5.3 % of source population) were matched to pegfilgrastim patients; cohorts were well-balanced on baseline characteristics. Second-cycle FN incidence proportions for comparison and pegfilgrastim patients were 3.8 versus 2.2 % based on broad definition and 2.6 versus 0.8 % based on narrow definition; corresponding OR were 1.7 (95 % CI 1.2–2.5, p = 0.002) and 3.5 (95 % CI 2.0–6.0, p < 0.001). Results were similar within cancer/regimen-subgroups and were robust when using alternative methods for confounding adjustment.ConclusionsIn this retrospective evaluation of cancer chemotherapy patients who received first-cycle pegfilgrastim prophylaxis in US clinical practice, a clinically relevant minority did not receive second-cycle prophylaxis. Second-cycle FN odds among this subset were significantly higher than they were among those who continued prophylaxis.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-015-3039-4) contains supplementary material, which is available to authorized users.
ISSN	09414355
Journal	Supportive Care in Cancer
Volume Number	24
PubMed Central reference number	PMC4846701
Issue Number	6
PubMed reference number	26670915
e-ISSN	14337339
DOI	10.1007/s00520-015-3039-4
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2015-12-15
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. © The Author(s) 2015
Subject Keyword	Febrile neutropenia Pegfilgrastim Neulasta Granulocyte colony-stimulating factor
Content Type	Text
Resource Type	Article
Subject	Rehabilitation Oncology (nursing) Oncology