Filgrastim prophylaxis in elderly cancer patients in the real-life setting: a French multicenter observational study, the TULIP study

Abstract

PurposeFew studies are currently available among elderly patients, justifying the need for better understanding of daily medical practices in terms of use of growth factors to prevent chemotherapy (CT)-induced neutropenia. The primary objective of this study was to describe the use of filgrastim in the elderly.MethodsCancer patients aged 65 years and above, undergoing CT and initiating a prophylactic treatment with filgrastim, were enrolled. Patients were followed according to routine medical practice from filgrastim initiation until the end of the CT or after a maximum of 6 cycles.ResultsOne thousand one hundred nineteen evaluable patients were documented in the study (mean age 73.9 ± 6.2 years, 52.1% men). The majority were suffering from solid tumor (73%) with ECOG 0–1 for 80% of them. Approximately two-third had a global risk for FN ≥ 20%, and one third < 20%. Through all CT cycles, no differences were observed between age classes ([65–74], [75–85], or > 85) in dose, duration, and time to first injection from CT start. Most patients (84%) received primary prophylaxis (PP) and 70% were administered during the first CT cycle. The median time from CT start until filgrastim was 4 days. The median duration of filgrastim treatment was 5 days. Dose reductions and CT delays were less frequent in patients receiving PP (4.8% and 7.1% respectively) than secondary prophylaxis (9.2% and 13.3% respectively).ConclusionsFilgrastim use was consistent with French Market Authorization terms. No difference was shown compared with younger patients. Safety data were consistent with the known safety profile.Electronic supplementary materialThe online version of this article (10.1007/s00520-019-04725-0) contains supplementary material, which is available to authorized users.

Biosimilar pegfilgrastim may offer affordable treatment options for patients in France: a budget impact analysis on the basis of clinical trial and real-world data

“…In the present study, an average of 3-5 days treatment duration per chemotherapy cycle for patients with shorting-acting G-CSFs was observed in practice, which was much shorter than an average treatment duration of 11 days adopted from clinical trials 19,20,33 . Notably, our data of shortacting G-CSFs usage obtained from real-world practice were consistent with two multicenter observational studies conducted in France 34,35 . Laribi et al 34 have found that among 1,119 elderly cancer patients, the median treatment duration of filgrastim was 5 days per chemotherapy cycle, regardless of primary prophylaxis or secondary prophylaxis.…”

“…Notably, our data of shortacting G-CSFs usage obtained from real-world practice were consistent with two multicenter observational studies conducted in France 34,35 . Laribi et al 34 have found that among 1,119 elderly cancer patients, the median treatment duration of filgrastim was 5 days per chemotherapy cycle, regardless of primary prophylaxis or secondary prophylaxis. Similarly, the ZOHe study which assessed the use of biosimilar filgrastim in routine practice in patients !18 years who were at risk of FN-inducing chemotherapy has shown that the median duration of planned filgrastim treatment was 5 days for all tumor subgroups and no patients were treated for more than 14 days 35 .…”

Prescription patterns of granulocyte colony–stimulating factors in patients with breast cancer: A real-world study

“…The observed low rate is likely due to the restrictions of reimbursement for G-CSFs under Taiwan’s National Health Insurance, which limits their use in solid tumors to treatment and secondary prophylaxis. Previous studies have reported that patients receiving high FN risk regimens who were given G-CSF as primary prophylaxis were less likely to have neutropenia-related dose delays and FN incidence compared to those who used it as secondary prophylaxis [ 24 , 25 ]. Future research with a larger sample size is needed to investigate the actual benefits of using G-CSF for primary prophylaxis versus secondary prophylaxis in Taiwan.…”

Clinical role of filgrastim in the management of patients at risk of prolonged severe neutropenia: An evidence‐based review

“…An interesting area is the use of G‐CSF prophylaxis in elderly patients. A French prospective trial analysed the use of filgrastim in this population (age ≥ 70 years), the authors reporting that filgrastim was usually prescribed as the PP and that chemotherapy delays and dose reductions were similar to those observed for their younger counterparts …”