A prospective cohort study to evaluate the incidence of febrile neutropenia in patients receiving pegfilgrastim on-body injector versus other options for prophylaxis of febrile neutropenia: breast cancer subgroup analysis

Reshma L. Mahtani, Rajesh Belani, Jeffrey Crawford, David Dale, Lucy DeCosta, Prasad L. Gawade, Chanh Huynh, Tatiana Lawrence, Sandra Lewis, William W. MacLaughlin, Mohit Narang, Robert Rifkin

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Breast cancer chemotherapy often carries a high risk of febrile neutropenia (FN); guidelines recommend prophylaxis with granulocyte colony-stimulating factor (G-CSF), such as pegfilgrastim. Neulasta® Onpro® on-body injector (OBI) is a delivery device administering pegfilgrastim approximately 27 h after application. Methods: This prospective study examined patients with breast cancer who received chemotherapy with a high risk of FN, receiving OBI (“OBI”) or other options (other G-CSF or none; “other”). The primary endpoint was FN incidence; secondary endpoints included chemotherapy delivery, adherence (G-CSF in all cycles), compliance (G-CSF day after chemotherapy), and FN incidence in patients receiving curative or palliative treatment. Results: A total of 1776 patients with breast cancer were enrolled (OBI, n = 1196; other, n = 580). Across all cycles, FN incidence was lower for OBI (4.4% [95% CI, 3.3–5.6%]) than other (7.4% [5.3–9.6%]). For curative treatment, the FN incidence across all cycles was lower for OBI (4.6% [3.4–5.8%]) than for other (7.1% [5.0–9.3%]). For palliative treatment (OBI, n = 33; other, n = 20), 3 patients (15%) in the other and none in the OBI group had FN. After adjusting for baseline covariates, FN incidence remained lower for OBI (4.6% [3.5–6.1%]) versus other (7.8% [5.7–10.5%]). Adherence was higher for OBI (93.8%) than for other G-CSF (69.8%), as was compliance (90.5 and 53.2%, respectively). Chemotherapy dose delays/reductions were similar for OBI (4.7%/32.3%, respectively) and other (4.7%/30.0%) groups. Conclusion: Pegfilgrastim OBI was associated with a lower FN incidence in patients with breast cancer compared to other options for FN prophylaxis. Trial registration: www.clinicaltrials.gov, NCT02178475, registered 30 June, 2014

Original languageEnglish (US)
JournalSupportive Care in Cancer
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Keywords

  • Breast cancer
  • Chemotherapy
  • Compliance
  • Febrile neutropenia
  • Pegfilgrastim

ASJC Scopus subject areas

  • Oncology

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