To compare the efficacy and safety of Day 2 (D2) once a cycle pegfilgrastim with Intermittent Every Other Days of 5 Shot (D3-11) filgrastim in early breast cancer patients treated with adjuvant Docetaxel, Doxorubicin, and Cyclophosphamide (TAC) regimen
According to manufacturers' recommendations (Amgen: Neupogenᵀᴹ), filgrastim are to start 24 hrs after the last dose of chemotherapy and continue until absolute neutrophil count (ANC) has recovered to within the normal range (or for 14 days). However, for economic and practical reasons and/or patient's convenience, it has been common practice to initiate filgrastim at a later days of cycle and/or administer a shorter course of treatment. Data from several clinical studies have shown that 10-11 days' filgrastim treatment is required for optimal prophylaxis for febrile neutropenia (FN), and data from other cancers shows that suboptimal use of G-CSFs could deteriorate clinical outcomes. However, in two recent randomized study with breast cancer patients undergoing TAC chemotherapy, acceptable incidence (7-18%) of FN was shown with the consecutive 6 or 7-daily filgrastim schemes. Also, although there is theoretical concern that there can be wide fluctuations in the patient's ANC over time in alternate or intermittent filgrastim administration, because there was no difference in clinical outcomes between daily- or intermittent-dose filgrastim schedules in previous literatures, the intermittent every other day of 5 shot-filgrastim scheme would have clinical outcomes comparable with previous consecutive 6 or 7-daily filgrastim schemes in coverage of ANC nadir. Therefore, it can be justified to investigate the non-inferiority of intermittent every other days of 5 shot-filgrastim scheme compared with control arm using of pegfilgrastim on D2.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
22
Filgrastim (Gracinᵀᴹ) is administered at the D3, D5, D7, D9, and D11 of each cycle. A dose of 5 μg/kg/day filgrastim is administered S.C. either as a bolus injection or as a continuous injection. Administer into the outer upper arm, abdomen (except within 2 inches of navel), front middle thigh, or the upper outer buttocks area.
Pegfilgrastim (Neulastaᵀᴹ) is administered at the D2 of each cycle. A dose of 6mg once a cycle is administered S.C., 24 (± 2) hours after completion of chemotherapy.
Asan Medical Center
Seoul, South Korea
Cumulative incidence of febrile neutropenia
Measured at the completion of cycle 3
Time frame: through the completion of cycle 1-3 (each cycle is 21 days), an average of 9 weeks
Incidence of febrile neutropenia at each cycle
Measured at the completion of each cycle 1, 2, and 3
Time frame: At each cycle 1, 2, and 3 (each cycle is 21 days)
Rates of anti-microbial use
Measured at the completion of cycle 3
Time frame: through the completion of cycle 1-3 (each cycle is 21 days), an average of 9 weeks
Duration of anti-microbial use
Measured at the completion of cycle 3
Time frame: through the completion of cycle 1-3 (each cycle is 21 days), an average of 9 weeks
Cumulative dose of chemotherapeutic agents
Measured at the completion of cycle 3
Time frame: through the completion of cycle 1-3 (each cycle is 21 days), an average of 9 weeks
Delay rate of next chemotherapy cycle due to inadequate neutrophil recovery
Measured at the completion of each cycle 1, 2, and 3
Time frame: At each cycle 1, 2, and 3 (each cycle is 21 days)
Duration of delay of next chemotherapy cycle due to inadequate neutrophil recovery
Measured at the completion of each cycle 1, 2, and 3
Time frame: At each cycle 1, 2, and 3 (each cycle is 21 days)
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