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Preventing Bone Pain from Pegfilgrastim

doi: 10.1097/01.COT.0000388284.97094.fd

Naproxen can help reduce the incidence and severity of bone pain related to pegfilgrastim and should be considered for patients receiving that agent as long as there are no contraindications. That was the conclusion of a multicenter randomized, double-blind placebo-controlled study from the University of Rochester Cancer Center reported at the ASCO Annual Meeting.

Jeffrey Kirshner, MD, explained that many clinicians use pegfilgrastim to stimulate neutrophil production and decrease the risk of neutropenia and neutropenia-related complications, but studies have shown that the agent increases bone pain in about 30% to 60% of patients.

The nationwide study by his group included 510 non-myeloid cancer patients, mean age of 55, with no contraindication to use a non-steroidal anti-inflammatory drug (NSAID). Patients were randomized to placebo (253 patients) or naproxen at 500 mg (257 patients) twice daily.

The patients received chemotherapy, and on Day 2, 3, or 4 received pegfilgrastim afterward. The researchers used a brief quality-of-life symptom inventory and pain medication use as study endpoints, and pain levels were recorded on a daily basis.

Patients who took naproxen had reduced pain (incidence, severity, and duration). There was no impact due to age or the type of cancer, and no significant toxicity. There were no increased complications or reports of increased GI bleeding or distress.

Teresa Gilewski, MD, the co-chair of the session where the study was presented, said that naproxen would be a reasonable approach to use for patients who have no contraindications to receiving an NSAID. “The pain incidence was still quite high, though, so we need to come up with better regimens,” she said. “Other questions remain, including would we see more toxicity if we used naproxen after every cycle of pegfilgrastrim? Do patients really need five days of naproxen? Is there a role for other NSAIDs or other pain medications alone or in combination?”

© 2010 Lippincott Williams & Wilkins, Inc.
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