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my personal edition > breast cancer > news
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DGReview
Pegfilgrastim Comparable in Safety to Filgrastim, Yet Allows More Convenient Dosing
A DGReview of :"Once-per-cycle pegfilgrastim (Neulasta) for the management of chemotherapy-induced neutropenia"
Seminars in Oncology
10/13/2003
By Emma Hitt, PhD
Pegfilgrastim (Neulasta), used for the management of chemotherapy-induced neutropaenia, can be administered once per cycle unlike filgrastim, which requires daily dosing. This dosing schedule may help improve patient quality of life and adherence.
Furthermore, clinical trials suggest that the safety profile of pegfilgrastim is comparable to that of filgrastim, according to the conclusion of a new review article.
In his report, Jeffrey Crawford, MD, with Duke University Medical Center, Durham, North Carolina, United States, reviewed the molecular characteristics of pegfilgrastim and the latest clinical trial data.
Pegfilgrastim is a longer-acting, self-regulating form of filgrastim created by the covalent linkage of a polyethylene glycol molecule to the filgrastim molecule. Like filgrastim, pegfilgrastim is a colony-stimulating factor indicated for decreasing the incidence of infection in patients with nonmyeloid malignancies treated with myelosuppressive chemotherapy. However, the "molecular characteristics of pegfilgrastim result in a longer terminal half-life, making once-per-chemotherapy-cycle administration possible," notes Dr. Crawford.
Unlike filgrastim, which undergoes predominantly renal elimination, pegfilgrastim is of sufficient size to minimise renal elimination. The primary route of clearance appears to be through neutrophil-receptor binding. The serum level is therefore inversely related to the absolute neutrophil count, which makes the pharmacokinetics of pegfilgrastim self-regulating and patient specific, he notes.
A single dose of pegfilgrastim provides neutrophil support comparable with that provided by an average of 11 daily injections of filgrastim, according to the findings of 2 randomised double-blind phase III clinical trials in breast cancer patients treated with myelosuppressive chemotherapy. In addition, pegfilgrastim has also been shown to be comparable to filgrastim in reducing neutropenic complications in patients treated with chemotherapy for lymphoma.
Pegfilgrastim has also been evaluated for safety in a trial of elderly patients with relapsed or refractory non-Hodgkin's lymphoma; relapsed or refractory lymphoma patients; and in patients with newly diagnosed non-Hodgkin's lymphoma.
"The safety profile of pegfilgrastim is comparable to that of filgrastim in the clinical settings studied to date," Dr. Crawford states. "The once-per-cycle administration of pegfilgrastim may improve patient quality of life because it is less disruptive to patients and caregivers, and increase adherence because no doses are missed, thus further advancing the management of chemotherapy-induced neutropenia and its consequences," he adds.
Semin Oncol. 2003;30(4 Suppl 13):24-30.
"Once-per-cycle pegfilgrastim (Neulasta) for the management of chemotherapy-induced neutropenia"
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