Pegfilgrastim (Neulasta)

A pegylated form of filgrastim (Neupogen).

Is longer acting than filgrastim and has negligible renal clearance and requires a single dose of administration

The modification in filgrastim leads to decrease renal clearance, longer circulatory plasma levels and allows single dosing her chemotherapy cycle.

Has efficacy similar to multiple dose filgrastim with respect the incidence and duration of febrile neutropenia.

Reduces incidence of febrile neutropenia in patients with nonmyeloid malignancies receiving myelopsuppressive chemotherapy.

Febrile neutropenia can lead to hospitalization and treatment with antibiotics, as well as chemotherapy dose delays, dose reductions and or treatment discontinuation.

Dose is 6 mg subcutaneous injection.

It should not be given between 14 days before and 24 hours after the initiation of cytotoxic chemotherapy.

Compared with filgrastim the number of days of severe neutropenia and absolute neutrophil count nadir, and time to absolute neutrophil count recovery are similar.

Recommendations for usage are for administration 24 hours after chemotherapy in 14 days before the next dose of chemotherapy due to the potential for increased sensitivity of rapidly dividing blood cells to cytotoxic chemotherapy.

Additional trials have shown that this lesion can be administered safely and effectively on the same day as chemotherapy (Lokich L).

In a randomized double-blind phase 2 study comparing same day versus next administration of pegfiilgrastim with carboplatinum and docetaxel revealed that duration of grade 4 neutropenia in cycle one was the same in both groups (Belani CP).

Treatment of patients with gynecologic malignancies and comparing pegfilgrastim day one versus day to administration resulted in same efficacy in the prevention of neutropenia, treatment delays and dose modifications (Whitworth JM).

Kaufman et al compared same day with next administration of this agent TAC chemotherapy for breast cancer and found that same day administration was less effective in reducing duration of severe neutropenia and this was associated higher rates of febrile neutropenia (Kaufman PA).

In any randomized double-blind phase 2 study comparing same day versus next day pegfilstrim with chemotherapy in non-Hodgkin’s lymphoma revealed no difference in the mean duration of grade 4 neutropenia in cycle one, however the same day therapy was less efficakcious in reducing the duration of severe neutropenia, and the absolute neutrophil count nadir was deeper in occurred earlier in the cycle(Saven A).

Mild to moderate bone pain is most common reported adverse event.

May be associated with splenic rupture including fatalities.

Acute respiratory distress syndrome can incur in patients receiving pelfilgrastim.

May cause sickle cell crises in patients with sickle cell disorders, and and fatal crises can occur.

In a randomized control study comparing filgrastim to pegfilgastrim bone pain, of any grade was similar for the two agents, 66%, and 62%, respectively (Gregory S).

In this above randomized study grade3/4 bone pain reported in , 8% of patients in the first four chemotherpay cycles and , <6% in the first chemotherpay cycle in both treatment groups.

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