Duke Cancer Institute, Duke Medicine, Durham, NC, USA.
Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
Cancer Treat Res Commun. 2021;29:100466. doi: 10.1016/j.ctarc.2021.100466. Epub 2021 Sep 25.
Evidence-based US guidelines provide recommendations for the use of granulocyte colony-stimulating factor (G-CSF) as supportive therapy in patients with cancer receiving chemotherapy. Pegfilgrastim is recommended for FN prophylaxis in patients with non-myeloid malignancies receiving a high-risk chemotherapy regimen, or an intermediate-risk regimen if one or more risk factors are present. The guidelines highlight the patient characteristics and chemotherapy regimens for solid tumors and hematologic malignancies that may influence a patient's overall risk of FN and may benefit from pegfilgrastim support. This review aimed to evaluate how pegfilgrastim use in patients with cancer receiving myelosuppressive chemotherapy in routine clinical practice aligns with evidence-based US guidelines. Examination of the literature revealed widespread deviation in relation to under- and over-prescribing, and timing of administration in US clinical practice. Pegfilgrastim is often over-prescribed in patients receiving palliative chemotherapy and those at low risk of FN. Potential under-prescribing of pegfilgrastim was also observed. In this literature search, data that appear to support same-day administration of pegfilgrastim were from uncontrolled studies that were limited in size. Analyses of healthcare claims data clearly favored next-day use, with statistically significant increases in FN incidence among patients receiving same-day pegfilgrastim versus those treated 1-4 days post-chemotherapy. Earlier-than-recommended administration typically occurs at the physician's discretion where next-day administration might present barriers to the patient receiving supportive therapy.There is a need to ensure appropriate prescribing to optimize patient outcomes, as deviation from the guideline recommendations was associated with increased incidence of FN and hospitalization.
基于证据的美国指南提供了关于使用粒细胞集落刺激因子 (G-CSF) 作为癌症患者接受化疗支持治疗的建议。培非格司亭推荐用于接受高风险化疗方案或存在一个或多个危险因素的非髓性恶性肿瘤患者的 FN 预防。该指南强调了可能影响患者 FN 总体风险并可能受益于培非格司亭支持的实体瘤和血液恶性肿瘤患者的特征和化疗方案。本综述旨在评估癌症患者在常规临床实践中接受骨髓抑制性化疗时使用培非格司亭与基于证据的美国指南的一致性。对文献的研究发现，在美国临床实践中，在开具处方的剂量、开具处方的时间方面存在广泛的不足和过度开具处方的现象。培非格司亭经常在接受姑息化疗和 FN 风险低的患者中过度开具处方。也观察到潜在的培非格司亭开具不足的情况。在本次文献检索中，似乎支持培非格司亭同日给药的数据来自规模有限的非对照研究。对医疗保健索赔数据的分析明显倾向于次日使用，与接受化疗后 1-4 天接受培非格司亭治疗的患者相比，同日接受培非格司亭治疗的患者 FN 发生率显著增加。通常，在医生的酌情权下提前给药，而次日给药可能会对患者接受支持性治疗带来障碍。需要确保适当的开具处方以优化患者的结局，因为偏离指南建议与 FN 发生率和住院率增加相关。
