Elderly cancer patients receiving chemotherapy benefit from first-cycle pegfilgrastim
Elderly cancer patients receiving chemotherapy benefit from first-cycle pegfilgrastim
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DOI：
10.1634/theoncologist.12-12-1416
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发表时间：
2007-01-01
期刊：
影响因子：
5.8
通讯作者：
Ershler, William B.
中科院分区：
文献类型：
--
作者：
Balducci, Lodovico;Al-Halawani, Hafez;Ershler, William B.
背景。有一种误解，认为老年癌症患者不能忍受标准剂量的化疗，因为骨髓抑制并发症的频率和严重程度。在这种情况下，通常观察到的反应性使用集落刺激因子（即对严重中性粒细胞减少症的反应）导致了这些并发症的频率和严重程度。本研究评估了从第1周期开始接受pegfilgrastin治疗的老年癌症患者发热性中性粒细胞减少症和相关事件的发生率（主动），并与第1周期后由医生决定开始使用pegfilgrastin（被动）进行比较。患有实体瘤或非霍奇金淋巴瘤（NHL）的患者（>= 65岁）被随机分配到主动或被动接受pegfilgrastim。主要终点是出现发热性中性粒细胞减少症的患者比例。共纳入852例患者（中位年龄72岁）。与被动使用pegfilgrastim相比，主动使用pegfilgrastim可显著降低实体瘤和NHL患者发热性中性粒细胞减少的发生率。积极使用pegfilgrastim也导致因中性粒细胞减少和发热性中性粒细胞减少而住院的人数减少了约50%。在实体瘤患者中，接受主动pegfilgrastim治疗的抗生素使用量较低，在两个NHL组中相同。这是评估典型老年癌症患者生长因子支持的最大的随机前瞻性试验。在接受一系列轻度至中度中性粒细胞减少化疗方案的老年实体瘤或NHL患者中，积极使用pegfilgrastim有效地降低了发热性中性粒细胞减少和相关事件的发生率。Pegfilgrastim应积极用于老年癌症患者，以支持标准化疗的最佳递送。
Background. There is a misconception that elderly cancer patients cannot tolerate standard doses of chemotherapy because of the frequency and severity of myelosuppressive complications. The reactive use of colony-stimulating factors (i.e., in response to severe neutropenia) commonly observed in this setting contributes to the frequency and severity of these complications. This study evaluated the incidence of febrile neutropenia and related events in elderly cancer patients receiving pegfilgrastim beginning with cycle 1 (proactive) in comparison with pegfilgrastim initiated after cycle 1 at the physician's discretion (reactive).Methods. Patients (>= 65 years of age) with either solid tumors or non-Hodgkin's lymphoma (NHL) were randomly assigned to receive pegfilgrastim either proactively or reactively. The primary endpoint was the proportion of patients experiencing febrile neutropenia.Results. There were 852 patients enrolled (median age, 72 years). Proactive pegfilgrastim use resulted in a significantly lower incidence of febrile neutropenia for both solid tumor and NHL patients compared with reactive use. Proactive pegfilgrastim use also led to fewer hospitalizations resulting from neutropenia and febrile neutropenia by approximately 50%. Antibiotic use was lower for solid tumor patients receiving proactive pegfilgrastim and equivalent in the two NHL groups.Conclusions. This is the largest, randomized, prospective trial evaluating growth factor support in typical elderly cancer patients. Proactive pegfilgrastim use effectively produced a lower incidence of febrile neutropenia and related events in elderly patients with either solid tumors or NHL receiving an array of mild to moderately neutropenic chemotherapy regimens. Pegfilgrastim should be used proactively in elderly cancer patients to support the optimal delivery of standard chemotherapy.