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Peg-filgrastim and cabazitaxel in prostate cancer patients

Di Lorenzo, Giuseppe; D'Aniello, Carmine; Buonerba, Carlo; Federico, Piera; Rescigno, Pasquale; Puglia, Livio; Ferro, Matteo; Bosso, Davide; Cavaliere, Carla; Palmieri, Giovannella; Sonpavde, Guru; De Placido, Sabino

doi: 10.1097/CAD.0b013e32835a56bc
CLINICAL REPORTS
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To determine the impact of prophylaxis with granulocyte-colony stimulating growth factor (G-CSF) on the risk of febrile neutropenia in a cohort of patients enrolled at the University Federico II of Naples and treated with cabazitaxel for metastatic castration-resistant prostate cancer (mCRPC). We carried out a retrospective review of prospectively collected data of patients enrolled at our institution in a compassionate-use programme with cabazitaxel, aimed at providing early access to the drug before its commercial availability in mCRPC patients. Besides baseline clinical and demographic characteristics, data on treatment efficacy and toxicity, as well as those on the use of G-CSF per patient per cycle were extracted. Progression-free survival and overall survival were calculated using the Kaplan–Meier method. Fisher’s exact test was used to explore a relationship between a single event of grade 3 or more neutropenia or febrile neutropenia and previous use of G-CSF. Univariate analysis was carried out to evaluate predictors of grade 3 or more neutropenia and/or febrile neutropenia. Of 34 patients enrolled at our institution from December 2010 to December 2011, 32 had received at least one dose of cabazitaxel and were included in the analysis. Patients received a median of 10 cabazitaxel cycles. Grade 3 or more neutropenia was common, occurring in 64.5% of patients. Three patients (9.3%) developed febrile neutropenia. Twenty-seven patients received prophylaxis with G-CSF during at least one cycle using peg-filgrastim. The risk of grade 3 or more neutropenia and/or febrile neutropenia per patient and per cycle was seven times lower when G-CSF was used. Baseline neutrophil count of less than 4570/mm3 was the strongest predictor of grade 3 or more neutropenia and/or febrile neutropenia. No toxic death was reported. Only one patient discontinued cabazitaxel because of an adverse event. Our analysis suggests that prophylaxis with peg-filgrastim may considerably reduce the incidence of grade 3 or more neutropenia and, possibly, of febrile neutropenia in mCRPC patients treated with cabazitaxel. Further analyses involving a larger population are warranted to confirm our results.

aGenitourinary Cancer Section and Rare-Cancer Center, Medical Oncology Division, Department of Endocrinology and Oncology, University Federico II, Napoli, Italy

bComprehensive Cancer Center, University of Alabama at Bimingham, Birmingham, Alabama, USA

Correspondence to Giuseppe Di Lorenzo, MD, PhD, Genitourinary Cancer Section and Rare-Cancer Center, Medical Oncology Division, Department of Endocrinology and Oncology, University Federico II, 80131 Naples, Italy Tel: +39 081 7463660; fax: +39 081 2203147; e-mail: giuseppedilorenzoncol@hotmail.com

Received August 16, 2012

Accepted September 12, 2012

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