Having neutropenia — a diminished level of white blood cells — is an ever-looming concern for patients undergoing chemotherapy. As an anticancer treatment works its way through the body in a bid to blitz cancerous cells, it can also damage neutrophils, a type of white blood cell essential to a functioning immune system. Without enough of them, the body is unable to fight off infection — bad for anyone, but especially bad for a cancer patient.
That’s why it’s critical to pair chemotherapy treatment with a medication that stimulates the growth of these white blood cells — but such paired treatments can actually be quite difficult to manage. The latter medication needs to be administered by injection about 24 hours after the chemotherapy, forcing many patients to return back to their treatment centers shortly after they’ve just been there, and making cancer treatment effectively a part-time job. It can also be difficult for medical centers to effectively coordinate the follow-up treatment within the necessary window of time. Additionally, the secondary appointments are an added cost for patients and providers.
A novel approach to tackling this burden is an on-body injector (OBI) for the drug pegfilgrastim (branded as Neulasta®). Through a subcutaneous needle that remains taped on the body, patients can self-administer their postchemotherapy pegfilgrastim dose from wherever they are without needing to return to a treatment center. But is this option preferred by everyone involved? Researchers in Germany presented a poster with results from the CONVENIENCE trial (ClinicalTrials.gov Identifier: NCT03619993) at the European Society for Medical Oncology’s (ESMO) Virtual Congress 2020 investigating this question.
The multicenter study looked at 404 patients who were being treated either for early breast cancer or non-Hodgkin lymphoma and who were randomly selected to receive pegfilgrastim either through an OBI or through injection from a prefilled syringe. The study followed the patients through 4 cycles of chemotherapy.
Ultimately, 43% of patients preferred OBI and 36% preferred the prefilled syringe, a difference the researchers say was not statistically significant. Both physicians and nurses preferred the prefilled syringe — physicians to a greater degree than nurses. For patients who preferred OBI, saving time and expenses was the most important factor in their decision, whereas patients who preferred the prefilled syringe said that the discomfort the OBI can cause, and their feeling that an injection administered by a professional is safer, were the most important factors in their decision.
But interestingly, the prefilled syringe was only preferred by patients who received all of their injections at a general practitioner’s office as opposed to getting them all at an oncology practice, or through a combination of locations. This suggests that preferences are tied not just to the experience of receiving an injection, but also to factors related to a patient’s access to different types of care settings.
The data from the ESMO presentation also showed that in spite of these mixed-bag preferences, OBIs are a consistently much better system for administering pegfilgrastim within the recommended time than prefilled syringes, despite whatever the preferences of the patients, physicians, or nurses may be: With OBIs, 97.6% of patients received their dose between 24 to 72 hours after chemotherapy, whereas only 63% of patients received their dose on time when returning to a treatment center for their injection.
Metz M, Semsek D, Rogmans G, et al. 1884P Patient, nurse and physician preferences: Final results of the CONVENIENCE study evaluating pegfilgrastim prophylaxis via pre-filled syringe or On-body injector (OBI) in cancer patients. Ann Oncol. 2020;31(supp 4):S1071. doi:10.1016/j.annonc.2020.08.1531