INDIANAPOLIS--(BUSINESS WIRE)--Nov. 3, 2016--
The use of white blood cell growth stimulating factor drugs to reduce
risk of infection in women with breast cancer receiving common
first-cycle chemotherapies only reduced hospitalization by 6 percent or
less, according to a study published in the Journal of Clinical
Oncology. The study also confirmed that fever and infections among
these women were very low even without the use of growth factor.
The study of medications that help white blood cell growth, also
known as granulocyte colony-stimulating factor or G-CSF, was authored by
representatives from HealthCore, Inc., Anthem, Inc. and the American
Society of Clinical Oncology. The authors of study are Abiy Agiro, Qinli
Ma, Anupama Kurup Acheson, Sze-jung Wu, Debra A. Patt, John J. Barron,
Jennifer L. Malin, Alan Rosenberg, Richard L. Schilsky, and Gary H.
Through the Choosing Wisely® campaign, ASCO issued guidance advising
oncologists not to use white cell stimulating factor for prevention of
neutropenia for patients with less than a 20 percent risk of getting an
infection. The three regimens studied have been considered
low-to-moderate risk for inducing neutropenia-related complications as
less than 20 percent of patients being treated with these chemotherapies
experience febrile neutropenia.
“In women with breast cancer treated with a conventional dose of
doxorubicin and cyclophosphamide, a chemotherapy regimen that has low
risk of infection, more than half of them were also treated with G-CSF,
with no benefit,” said Abiy Agiro, lead author and research manager for
HealthCore. “This is unfortunate, especially given that patients can
experience uncomfortable side effects from G-CSF, such as bone pain,
headache and nausea. When the chemotherapy risk for neutropenia is low,
these high-cost agents place an unnecessary burden on the healthcare
system without providing a discernable benefit to the patient.”
The retrospective analysis included patients with breast cancer who
began first-cycle chemotherapy from 2008 to 2013 using docetaxel and
cyclophosphamide, also known as TC or carboplatin, docetaxel and
trastuzumab, also known as TCH or doxorubicin, and cyclophosphamide,
also known as conventional dose AC.
“This study confirms previous trials that have shown that G-CSF is
effective at decreasing fever and infections with higher-risk
chemotherapy treatments but failed to show any benefit with lower-risk
regimens,” said Dr. Gary Lyman, co-director of the Hutchinson Institute
of Cancer Outcomes Research for the Fred Hutchinson Cancer Research
Center. “The study also showed that older age was associated with
increased risk of neutropenia-related hospitalization, however the
health care community needs to study G-CSF further to better understand
which patients on which chemotherapies can benefit most.”
The group of patients treated with doxorubicin and cyclophosphamide and
G-CSF actually showed more patients experiencing neutropenia than those
not taking any G-CSF, however the difference was not significant,
according to the study. However, hospitalizations occurred
in 2 percent of patients with TC docetaxel and cyclophosphamide and
G-CSF, and 7.1 percent with no G-CSF. For TCH carboplatin, docetaxel and
trastuzumab regimens, neutropenia occurred in 1.3 percent of the
patients with G-CSF and 7.1 percent with no G-CSF.
Although G-CSF was associated with a lower rate of hospitalization in
low to modest benefit in TC and TCH regimen, the value of G-CSF
treatment in such regimens is less clear. For all regimens excluding
high risk chemotherapy, about 48 patients would need to be treated at a
total cost of more than $200,000 to prevent one more neutropenia related
hospitalization compared to patients who did not receive G-CSF.
“In spite of current guidelines and public campaign efforts about
appropriate use of G-CSF prophylaxis, it is commonly used in
chemotherapy regimens that do not have high risk for inducing
neutropenia-related complications,” said Dr. Debra Patt, vice president
of Texas Oncology. “Our study found no benefit in one regimen, and even
when low to modest benefit is observed, the value proposition for such
wide spread use of G-CSF is limited. Future research that integrates HIT
platforms, such as ASCO’s CancerLinQ™, could refine the methods to
identify patients for a targeted use of G-CSF.”
About HealthCore, Inc.
HealthCore, Inc. is the wholly-owned, independently operating health
outcomes research subsidiary of Anthem (NYSE: ANTM), Inc. We work with
life sciences companies, payers and providers, and government and
academic organizations to provide real-world evidence in support of a
wide variety of health care decisions. Our research capabilities include
extensive experience in HEOR, Late Phase, Safety and Epidemiology and
Survey-Based research services and solutions with our work designed to
improve quality, safety and affordability in health care. With more than
20 years of experience, clinical and scientific research expertise, and
exclusive access to a robust, integrated research environment containing
information on nearly 60 million individuals from multiple health plans
across the U.S., HealthCore delivers unparalleled clarity and actionable
information to health care decision makers. To learn more about
HealthCore, go to www.healthcore.com.
About Anthem, Inc.
Anthem is working to transform health care with trusted and caring
solutions. Our health plan companies deliver quality products and
services that give their members access to the care they need. With over
73 million people served by its affiliated companies, including nearly
40 million enrolled in its family of health plans, Anthem is one of the
nation’s leading health benefits companies. For more information about
Anthem’s family of companies, please visit www.antheminc.com/companies.
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Source: Anthem, Inc.