Use of affront pegfilgrastim in elderly patients receiving chemotherapy
Even though cancer most commonly develops in elderly population, they have not been amply represented in clinical trial. Many earlier clinical trials excluded elderly patients because of fear of poor performance on the study. Many were concerned about tolerability of full dose chemotherapy in elderly patients because of a common feeling that the elderly cancer patients may easily develop fever and neutropenia (febrile neutropenia). Most community practices use lower doses of chemotherapy to treat elderly patients. To solve these issues researchers have established the Geriatric Oncology Consortium (GOC), which includes a co-operative group of community practices, to fill this gap in data for the elderly patients with diagnosis of cancer.
Findings of a recent GOC study were presented at American Society of Clinical Oncology (ASCO) meeting that was held in May 2005. As per the researchers this was the largest prospective study till then focusing on the side effects of chemotherapy in elderly population. The study was presented by Lodovico Balducci MD, Professor of Medicine and Oncology a t University of South Florida College of Medicine.
This study evaluated 701 patients who were 65 years or older. Median age of the study group was 72 years. These patients had various types of cancer including lung cancer, breast cancer, or ovarian cancer. Patients received growth factor support using pegfilgrastim (Neulasta) from the beginning of the chemotherapy schedule (349 patients) or started later if needed as per the discretion of the treating oncologist (352 patients). Researchers also studied a separate group of 151 patients with non-Hodgkin's lymphoma (results from this group was not included in the current result).
The chemotherapy drugs used in this group of patients included carboplatin with paclitaxel (29%) or docetaxel (10%) etoposide (12%) and doxorubicin with cyclophosphamide (12%).
Results from the trial showed affront use of pegfilgrastim in the first cycle of chemotherapy decreased the incidence of febrile neutropenia by 60%. Affront use of growth factor also reduced the need for dose reductions by 50%. These patients who received pegfilgrastim starting with the first cycle also had about 50% reduction in febrile neutropenia related hospitalizations (5% Vs 9%). The incidence of neutropenia in the first cycle of treatment was 68% in the group randomized to physician's discretion compared to 26% in the primary prophylactic group who received pegfilgrastim with the first cycle of treatment. Incidence of febrile neutropenia was 3% in patients who received affront dose of pegfilgrastim compared to 7% in the group left to physician's discretion. Overall the affront use of growth factor translate into use of full dose of chemotherapy with less complications and hospitalizations in elderly patients with diagnosis of cancer. The current NCCN guidelines have also been modified based on this data.
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