First analysis of same-day pegfilgrastim use with concurrent capecitabine-based regimens in pts with GI malignancies

• Published in: Journal of clinical oncology Vol. 38; no. 4_suppl; p. 817
• Main Authors: Hakim, Nausheen, Chi, Jeffrey, Rehman, Hasan, Goyal, Shreya Prasad, Olazagasti, Coral, Moriarty, Linda, Jose, Jyothi, Lamont, Carol, Saif, Wasif M.
• Format: Journal Article
• Language: English
• Published: 01.02.2020
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2020.38.4_suppl.817

Abstract only 817 Background: Pegfilgastrim is administered 24 hrs after chemotherapy to reduce risks of myelosuppression. This requires an additional clinic visit, which can be difficult for some patients (pts) due to work and transportation issues. In GI malignancies, pts receiving capecitabine-based regimens also require pegfilgastrim to reduce myelotoxicity. Capecitabine is converted to active 5-FU by cytidine deaminase which is present in humans in low levels and generally does not cause severe myelosupression. Therefore, administering pefilgastrim concurrently with chemotherapy may be an option. We present here the first study to analyze safety and efficacy of administering pegfilgrastim on the same day as capecitabine-based regimens in patients with GI malignancies. Methods: We evaluated 157 pts with GI malignancies who received a capecitabine-based chemotherapy regimens, including XELOX, EOX, ECX, XELIRI, MIXE, gemcitabine-capecitabine and same-day pegfilgrastim (6 mg) within 1 hr of completion of systemic agents. As per institutional guidelines, pts were counseled on risks of same-day pegfilgrastim prior to its administration. Pts were followed to determine the degree of neutropenia and toxicity. Results: A total of 914 chemotherapy cycles in 157 pts were analyzed. Median ANC nadir for all cycles was 5634/uL (range: 450-23800). Grade 1 and 2 neutropenia developed in 11 of 914 cycles. Bone pain reported in 9 pts. There was 1 episode of grade >3 neutropenia resulting in infection and antibiotic use. No other pt required dose reductions, chemotherapy delays, or hospitalizations. No increased toxicity of capecitabine was noticed. Conclusions: We believe our study is the first in GI malignancies to report that same-day pegfilgrastim administration with capecitabine-based regimens may be as effective and safe as next-day administration. Additionally, given the absence of CD in human bone marrow, it appears capecitabine can be used concurrently with pegfilgastrim. Prospective studies should be done to further investigate, as this practice can benefit pts clinically, decrease office visits, increase pt satisfaction and reduce healthcare costs.