Is it safe to administer pegfilgrastim upon completion of 5-fluorouracil infusion?

It is safe to administer pegfilgrastim on the final day of 5-fluorouracil (5-FUCI), as suggested by the low risk of grade 3 and 4 neutropaenia, febrile neutropaenia, and dose delays or reduction, according to a recent study.

“Pegfilgrastim, a long-acting granulocyte-colony-stimulating factor used to prevent neutropaenia, is not indicated for administration within 24 h of completion of chemotherapy,” the authors said.

This institutional retrospective analysis was carried out to assess the safety of administering pegfilgrastim in gastrointestinal cancer chemotherapy regimens containing continuous intravenous infusion of 5-FUCI on the day of 5-FUCI completion.

The authors sought to determine the incidence of grade 3 and 4 neutropaenia and febrile neutropaenia when pegfilgrastim was administered on the final day of 5-FUCl (primary endpoint), as well as the rate of dose reductions and treatment delays (secondary endpoint).

Three hundred patients were included in the review from January 2010 to May 2017. Pancreatic cancer (60 percent) was the most common illness, followed by colorectal cancer (25 percent), with 77 percent of the patients having late-stage disease.

Patients were found to have a 0.010-risk (95 percent confidence interval [CI], 0.001–0.029) of developing grade 3 neutropaenia and 0.007 (95 percent CI, 0.001–0.024) for grade 4 neutropaenia. For febrile neutropaenia, the risk was 0.007 (95 percent CI, 0.001–0.024).

The risk of treatment delay was 0.013 (95 percent CI, 0.004–0.034) and treatment reduction 0.010 (95 percent CI, 0.002–0.029).

“Limitations of this study were that it was retrospective in nature and was conducted at a single institution,” the authors noted.