Impact of Hematopoietic Growth Factors on Blood Transfusion Needs, Incidence of Neutropenia, and Overall Survival Among Elderly Advanced Ovarian Cancer Patients Treated With Chemotherapy.

Abstract

OBJECTIVE:

To determine the effectiveness of erythropoietin-stimulating agent (ESA) and granulocyte colony-stimulating factor (CSF) in reducing blood transfusion needs and neutropenia incidence in community-dwelling elderly ovarian cancer patients.

METHODS:

The SEER (Surveillance Epidemiology and End Results)-Medicare database was used to identify 5572 women with stage III/IV ovarian cancer who received chemotherapy. To assess clinical effectiveness, we categorized patients based on the number of administrations of ESA (ie, epoetin-alfa and darbepoetin-alfa) and CSF (ie, filgrastim and pegfilgrastim). To evaluate effect on survival, patients were categorized as receiving ESA only, CSF only, ESA + CSF, and no ESA/CSF.

RESULTS:

Two thirds of patients received growth factor support (24% ESA only, 13% CSF only, 30% ESA + CSF). Depending on the number of epoetin-alfa administrations, ESA was associated with 48% to 56% lower need for blood transfusion compared with no ESA (hazard ratio for 1-3 claims, 0.47; 4-6 claims, 0.52; 7-10 claims, 0.48; ≥11 claims, 0.44). Patients who received at least 3 prophylactic filgrastim administrations had 71% to 98% lower risk of developing neutropenia (hazard ratio for 3-4 claims, 0.29; ≥5 claims, 0.02) compared with those without CSF. Effectiveness was comparable for darbepoetin-alfa and pegfilgrastim use. Overall survival was longer in those who received CSF only; however, the risk of mortality after 24 months was higher in those who received ESA (P = 0.0005). All models were adjusted for relevant covariates.

CONCLUSIONS:

Erythropoietin-stimulating agents were effective in reducing blood transfusion need. Granulocyte colony-stimulating factors were effective in lowering neutropenia incidence and also were associated with improved survival in elderly ovarian cancer patients. Findings are consistent with clinical trials and clinical guidelines.

• Authors: Insiya B Poonawalla, Linda B Piller, David R Lairson, Wenyaw Chan, Xianglin L Du
• Journal: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (Int J Gynecol Cancer) Vol. 26 Issue 1 Pg. 95-103 (Jan 2016) ISSN: 1525-1438 [Electronic] England
• PMID: 26509851 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Recombinant Proteins
• Erythropoietin
• Granulocyte Colony-Stimulating Factor
• pegfilgrastim
• Polyethylene Glycols
• Filgrastim

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Blood Transfusion
• Combined Modality Therapy
• Erythropoietin (therapeutic use)
• Female
• Filgrastim
• Follow-Up Studies
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Humans
• Incidence
• Middle Aged
• Needs Assessment
• Neoplasm Staging
• Neutropenia (epidemiology)
• Ovarian Neoplasms (drug therapy, mortality, pathology)
• Polyethylene Glycols
• Prognosis
• Recombinant Proteins (therapeutic use)
• Retrospective Studies
• SEER Program
• Survival Rate