Pfeil, A.M., Allcott, K., Pettengell, R., von Minckwitz, G., Schwenkglenks, M., & Szabo, Z. (2015). Efficacy, effectiveness and safety of long-acting granulocyte colony-stimulating factors for prophylaxis of chemotherapy-induced neutropenia in patients with cancer: A systematic review. Supportive Care in Cancer, 23, 525–545. 

DOI Link

Purpose

STUDY PURPOSE: To review the efficacy, effectiveness and safety of neutropenia prophylaxis with use of long-acting G-CSFs in patients with cancer undergoing chemotherapy
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, and Cochrane Library
 
KEYWORDS: Balugrastim, granulocyte–colony-stimulating factor, lipegfilgrastim, neutropenia, pegfilgrastim, systematic review
 
INCLUSION CRITERIA: Clinical trials and observational studies in which patients had received long-acting granulocyte–colony-stimulating factors (G-CSF) primary prophylaxis to reduce the risk of chemotherapy-induced neutropenia (CIN) during chemotherapy
 
EXCLUSION CRITERIA: Patients who underwent stem cell transplant, editorials, letters, case reports, guidelines, health technology assessment reports, economic evaluations, narrative reviews, and research protocols; studies comparing pegfilgrastim with a daily G-CSF, placebo, or no prophylaxis if there were fewer than 50 patients; studies with pegfilgrastim alone if fewer than 100 patients received pegfilgrastim; pegfilgrastim used outside of approved indication; and studies that did not report neutropenia-related outcomes

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 731 full publications and 108 Congress abstracts; duplicates were removed, leaving 700 items

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 44 (33 full papers and 11 congress abstracts) 
 
TOTAL PATIENTS INCLUDED IN REVIEW = 58,342 patients
 
KEY SAMPLE CHARACTERISTICS: Studies in patients with breast cancer were dominant; however, the studies included a range of patient populations and cancer types and stages as well as chemotherapy regimens.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Pegfilgrastim did not consistently show better efficacy or effectiveness in all studies, but the vast majority showed better efficacy and effectiveness compared to daily G-CSF, no upfront pegfilgrastim, no G-CSF or placebo in regards to CIN, febrile neutropenia (FN), chemotherapy dose reductions/delays, antibiotic use, and neutropenia-related hospitalizations. It is suggested that pegfilgrastim has an acceptable safety profile with similar AEs between pegfilgrastim and filgrastim.

Conclusions

Pegfilgrastim is currently being widely used in clinical practice, showing similar efficacy/effectiveness with acceptable safety profiles.

Limitations

Limitations include the quality of the underlying studies. Some studies did not report number of patients receiving primary prophylaxis versus secondary prophylaxis, which may have led to underestimation of effectiveness. Studies were not consistent in their definitions of FN and CIN. Combined measures of effect are missing in the analysis.

Nursing Implications

Further studies in broader patient populations are needed to confirm. This review adds to the body of evidence that shows mixed findings regarding the question of whether pegfilgrastim use achieves better patient outcomes than daily filgrastim. It is also unclear if either of these has better results for primary or secondary prophylaxis.

Legacy ID

5803