filgrastim [G-CSF] (Neupogen, Lenograstim, Granulokine)
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Introduction
Tradename: Neupogen.
Biosimilar filgrastim-sndz (Zarxio) FDA-approved March 2015.
Indications
- myelosuppression in cancer patients
- adults with AML or myelodysplastic syndrome
- no effect on disease-free time
- decreased fevers, antibiotics, hospitalization
- decreased need for antifungal therapy
- risk of febrile neutropenia is > 20%[4]
- pediatric patients with ALL
- shorter hospitalizations & fewer infections
- no change in 3 year survival
- adults with AML or myelodysplastic syndrome
- myelosuppression in stem cell transplantation or bone marrow transplantation (BMT)
- HIV therapy-induced myelosuppression when a change in medication regimen is contraindicated
- absolute neutrophil count < 100/uL expected for > 7 days
Contraindications
- risk of febrile neutropenia < 10%[4]
- most afebrile patients with neutropenia[3]
- routine adjunct to empiric antibiotics presnting with febrile neutropenia[3]
- routine adjunct for induction therapy for acute leukemia[3]
Dosage
- round all doses to nearest vial size
- 5-10 ug/kg/day SC or IV for 14 days or until neutrophil count > 10,000/mm3 (5000/mm3 for HIV)
- begin 1 or 2 days after chemotherapy
- continue full dose of chemotherapy unless overwise indicated[3] Injectable: 300 ug/mL (1 & 1.6 mL vials), syringe: 2.5-3 mL, needle 25 g, 5/8 inch
Pharmacokinetics
- rapidly absorbed after SC administration
- response is noted in 24 hours; plateau in 3-5 days
- elimination: 1st order, 1/2 life 3-4 hours
- pegfilgrastim: action for several weeks
Adverse effects
- common (> 10%)
- less common (1-10%)
- anorexia, dyspnea, headache, cough, skin rash, chest pain, weakness, sore throat, stomatitis, constipation, pain at injection site, leukocytosis, fluid retention
- uncommon (< 1%)
- other
- bone pain
- hypotension
- splenomegaly with long-term use
- osteoporosis
- neutrophilic dermatosis
Mechanism of action
- human recombinant G-CSF
- O-glycan consisting of gal-galNAc disaccharide which can be modified with up to two sialic acid residues (done in recombinantly expressed G-CSF from CHO cells)
- stimulates leukopoiesis & enhances the actions of mature neutrophils
More general terms
More specific terms
References
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19 American College of Physicians, Philadelphia 2015, 2018, 2022.
- ↑ 4.0 4.1 4.2 Myeloid Growth Factors National Comprehensive Cancer Network In: Anello J, Feinberg B, Heinegg J et al New Clinical Practice Guidelines, February 2018. Medscape. February 07, 2018 https://reference.medscape.com/viewarticle/892328
Crawford J, Becker PS, Armitage JO, et al. Myeloid Growth Factors, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017 Dec;15(12):1520-41. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29223990 <Internet> http://www.jnccn.org/content/15/12/1520.long - ↑ Smith TJ, Bohlke K, Lyman GH et al Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2015 Oct 1;33(28):3199-212. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26169616