Chemotherapy-induced febrile neutropenia (FN) is a medical emergency that may occur in patients with
malignancies receiving myelosuppressive
chemotherapy. FN requires early therapeutic intervention since it is associated with increased hospitalizations and high mortality risk of 5%-20%. FN-related hospitalizations are higher in patients with myeloid
malignancies than in those with solid
tumors due to the myelotoxicity of
chemotherapy regimens and the compromised bone marrow function. FN increases the burden of
cancer by causing
chemotherapy dose reductions and delays. The administration of the first
granulocyte colony-stimulating factor (
G-CSF)
filgrastim reduced the incidence and duration of FN in patients undergoing
chemotherapy.
Filgrastim later evolved into
pegfilgrastim, which has a longer half-life than
filgrastim and is associated with a lower rate of severe
neutropenia,
chemotherapy dose reduction, and
treatment delay. Nine million patients have received
pegfilgrastim since its approval in early 2002. The
pegfilgrastim on-body injector (OBI) is an innovative device facilitating the time-released auto-injection of
pegfilgrastim approximately 27 h after
chemotherapy, as clinically recommended for the prevention of FN, thus eliminating the need for a next-day hospital visit. Since its introduction in 2015, one million patients with
cancer have received
pegfilgrastim using the OBI. Subsequently, the device was approved in the United States (US), European Union, Latin America, and Japan, with studies and a postmarketing commitment demonstrating device reliability. A recent prospective observational study conducted in the US demonstrated that the OBI substantially improved the adherence to and compliance with clinically recommended
pegfilgrastim therapy; patients receiving
pegfilgrastim via the OBI experienced a lower incidence of FN than those receiving alternatives for FN prophylaxis. This review discusses the evolution of G-CSFs leading to the development of the OBI, current recommendations for
G-CSF prophylaxis in the clinic, continued evidence supporting next-day
pegfilgrastim administration, and improvements in patient care made possible with the OBI.