Does pegfilgrastim reduce the incidence of neutropenic sepsis?


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Rachel Nirsimloo1,David Cameron2,Jacqueline Grove1
1Edinburgh Cancer Centre,2University of Edinburgh

Abstract

Background

Febrile neutropenia (FN) is still a cause of death in cancer patients with an estimated 1 in 500 people diagnosed with cancer dying from FN. There is also evidence to suggest that although the number of cancers being diagnosed each year is rising, as a proportion of those, so is the relative rate of deaths from FN.

As well as prompt diagnosis, early treatment, improving patient education and access to hospital, GCSF primary prophylaxis is recommended by ASCO, EORTC and SCAN when when the risk of FN is 20% or higher

In the Edinburgh Cancer Centre local audit data showed that with breast cancer patients receiving FEC-T chemotherapy the incidence of FN was 32%. In 2013 we started given prophylactic pegfilgrastim 6mg s/c 24hrs after docetaxel chemotherapy to reduce incidence to 5.5%. The data was re-audited to assess the impact.

Method

Every patient audited who was allocated FEC-T chemotherapy between January 2013 and December 2014 inclusive. Data was collected on Tumour pathology, number of intended cycles, number of admissions with and without FN, length of stay and any dose modifications/delays or relapses/deaths.

Results

Patient numbers were much higher than anticipated and FN accounted for 19% of all admissions. The annual incidence was 37%. Of those FN incidents 52.9% occurred during FEC phase and 47.1% during docetaxel. This equals an admission rate/patient on docetaxel when taking pegfilgrastim as 17.7%. Mean length of stay during FN was 2 days. No deaths recorded. 4.8% of admissions were due to side effects of pegfilgrastim.

Conclusion

Primary prophylaxis with GCSF does reduce incidence of FN but not by the anticipated percentage. Length of stay has been reduced but admissions and investigations due to side effects of pegfilgrastim was not anticipated nor costed for. FEC is more myelosuppressive than estimated and should also be given primary prophylaxis with GCSF.