BACKGROUND: A phase III study of filgrastim as an adjunct to combination chemotherapy in previously untreated patients with limited- or extensive-stage small-cell lung cancer was conducted. This final analysis explores baseline factors that might predict febrile neutropenia and also reports the results of 463 open-label filgrastim cycles that were delivered after patients' initial episode of the primary endpoint, ie, febrile neutropenia. PATIENTS AND METHODS: A total of 244 patients were randomized to receive placebo or filgrastim in </= 6 cycles of chemotherapy (cyclophosphamide/doxorubicin/etoposide). RESULTS: The cumulative percent of patients receiving filgrastim who experienced febrile neutropenia was approximately 50% lower than those given placebo (38% vs. 74%, respectively; P < 0.0001). Significant treatment-related reductions were also seen in the incidence and duration of grade 4 neutropenia. Cycle 1 displayed the highest incidence of neutropenia with or without fever and the longest duration of neutropenia relative to later cycles. Patients crossing over to open-label filgrastim from their blinded treatment assignment displayed event rates similar to those in the blinded filgrastim group. Patients who experienced febrile neutropenia in cycle 1 were at a significantly higher risk for subsequent events compared with those who were event-free in cycle 1. Women displayed a higher risk for febrile neutropenia than men, but no other baseline risk factors were detected. CONCLUSION: Given the high rate of febrile neutropenia in cycle 1 and the higher risk for subsequent events in patients with a cycle 1 event, we conclude that growth factor administration starting in cycle 1 should be considered for patients receiving moderately to highly myelosuppressive chemotherapy regimens.
RCT Entities:
BACKGROUND: A phase III study of filgrastim as an adjunct to combination chemotherapy in previously untreated patients with limited- or extensive-stage small-cell lung cancer was conducted. This final analysis explores baseline factors that might predict febrile neutropenia and also reports the results of 463 open-label filgrastim cycles that were delivered after patients' initial episode of the primary endpoint, ie, febrile neutropenia. PATIENTS AND METHODS: A total of 244 patients were randomized to receive placebo or filgrastim in </= 6 cycles of chemotherapy (cyclophosphamide/doxorubicin/etoposide). RESULTS: The cumulative percent of patients receiving filgrastim who experienced febrile neutropenia was approximately 50% lower than those given placebo (38% vs. 74%, respectively; P < 0.0001). Significant treatment-related reductions were also seen in the incidence and duration of grade 4 neutropenia. Cycle 1 displayed the highest incidence of neutropenia with or without fever and the longest duration of neutropenia relative to later cycles. Patients crossing over to open-label filgrastim from their blinded treatment assignment displayed event rates similar to those in the blinded filgrastim group. Patients who experienced febrile neutropenia in cycle 1 were at a significantly higher risk for subsequent events compared with those who were event-free in cycle 1. Women displayed a higher risk for febrile neutropenia than men, but no other baseline risk factors were detected. CONCLUSION: Given the high rate of febrile neutropenia in cycle 1 and the higher risk for subsequent events in patients with a cycle 1 event, we conclude that growth factor administration starting in cycle 1 should be considered for patients receiving moderately to highly myelosuppressive chemotherapy regimens.
Authors: Markus Joerger; Stefanie Kraff; Alwin D R Huitema; Gary Feiss; Berta Moritz; Jan H M Schellens; Jos H Beijnen; Ulrich Jaehde Journal: Clin Pharmacokinet Date: 2012-09-01 Impact factor: 6.447
Authors: Constantin Volovat; Igor M Bondarenko; Oleg A Gladkov; Reiner Elsässer; Anton Buchner; Peter Bias; Udo Müller Journal: Springerplus Date: 2015-07-03
Authors: Yong Won Choi; Seong Hyun Jeong; Mi Sun Ahn; Hyun Woo Lee; Seok Yun Kang; Jin-Hyuk Choi; U Ram Jin; Joon Seong Park Journal: J Korean Med Sci Date: 2014-11-04 Impact factor: 2.153