A neu approach.

In 2018, CMS spent nearly $1.4 billion on peg-filtrastim (aka Neulasta) compared to the estimated $2.4 billion spent on radiation...all of radiation. With that in mind, this phase 2 trial explored the safety of omitting peg-filgrastim during the paclitaxel portion of the dose dense ACT adjuvant chemo regimen for breast cancer. Rates of neutropenia are high during the AC portion of therapy, but it’s hypothesized that lower rates of neutropenia during paclitaxel reduces the benefit of continued support. Importantly, the population in this study was a fairly select group <65 years old with good performance status. Among such 125 women, 90% were able to complete the four planned cycles of paclitaxel in under 7 weeks. In fact, the most common reasons for not finishing were non-hematologic. Only 4% developed neutropenia, and only 6% were prescribed peg-filgrastim, which resulted in a >95% reduction in peg-filgrastim use during dose-dense paclitaxel. TBL: The majority of young, healthy women receiving dose dense ACT for breast cancer are able to safely omit prophylactic peg-filgrastim during the paclitaxel portion of their therapy. | Vaz-Luis, J Clin Oncol 2020