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The safety and efficacy of day 1 versus day 2 administration of pegfilgrastim in patients receiving myelosuppressive chemotherapy for gynecologic malignancies.

AbstractOBJECTIVE:
Pegfilgrastim is indicated to decrease the incidence of febrile neutropenia in patients with gynecologic malignancies who are receiving myelosuppressive chemotherapy. We sought to compare the safety and efficacy of day 1 pegfilgrastim administration to day 2 administration in patients with gynecologic malignancies.
METHODS:
We retrospectively evaluated patients receiving both chemotherapy and pegfilgrastim from June 1, 2006 to August 31, 2007 for a gynecologic malignancy. Abstracted data included patient demographics, pathology, blood counts, toxicity, and chemotherapy. After administration of chemotherapy, all patients either received 6 mg of pegfilgrastim subcutaneously on day 1 or day 2.
RESULTS:
1226 administrations of pegfilgrastim in 230 patients were identified. 490 administrations of pegfilgrastim were given on day 1 compared to 736 on day 2. 70% of patients had ovarian cancer with a median age of 64 years (range 15-88). 79% of patients had stage III, IV, or recurrent disease and 67% were undergoing primary chemotherapy. The most common chemotherapy was docetaxel/carboplatin (53%) followed by paclitaxel/carboplatin (19%). The mean absolute neutrophil count (ANC) nadir was 4810/mm(3) in the day 1 cohort compared to 4212/mm(3) in the day 2 cohort (p=.004). The incidence of Grade 3/4 neutropenia was similar in both groups (4.9% in day 1 vs. 5.7% in day 2; p=.63). Grade 3/4 febrile neutropenia was uncommon in both cohorts (0 episodes vs. 3 episodes; p=.41). Treatment delays were similar in both cohorts (5.9% vs. 7.5%; p=.35). Dose modifications were also similar in both cohorts (2.8% vs. 5.3%; p=.06).
CONCLUSION:
Day 1 administration of pegfilgrastim is as effective as day 2 administration in the prevention of neutropenia in patients with gynecologic malignancies. Treatment delays and dose modifications were not increased after day 1 administration of pegfilgrastim. Administering pegfilgrastim on day 1 appears to be safe, effective, and convenient in selected patients receiving myelopsuppressive chemotherapy for gynecologic malignancies.
AuthorsJenny M Whitworth, Kellie S Matthews, Kimberly A Shipman, T Michael Numnum, James E Kendrick, Larry C Kilgore, J Michael Straughn Jr
JournalGynecologic oncology (Gynecol Oncol) Vol. 112 Issue 3 Pg. 601-4 (Mar 2009) ISSN: 1095-6859 [Electronic] United States
PMID19110303 (Publication Type: Journal Article)
Chemical References
  • Recombinant Proteins
  • Taxoids
  • Granulocyte Colony-Stimulating Factor
  • Docetaxel
  • pegfilgrastim
  • Polyethylene Glycols
  • Carboplatin
  • Paclitaxel
  • Filgrastim
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
  • Carboplatin (administration & dosage, adverse effects)
  • Docetaxel
  • Drug Administration Schedule
  • Female
  • Filgrastim
  • Genital Neoplasms, Female (blood, drug therapy)
  • Granulocyte Colony-Stimulating Factor (administration & dosage)
  • Humans
  • Middle Aged
  • Neutropenia (chemically induced, prevention & control)
  • Paclitaxel (administration & dosage, adverse effects)
  • Polyethylene Glycols
  • Recombinant Proteins
  • Retrospective Studies
  • Taxoids (administration & dosage, adverse effects)
  • Young Adult

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