Advances in the pharmacological management of neutropenia in solid tumors: the advent of biosimilars

ABSTRACT

Introduction: Severe neutropenia and infections are potentially life-threatening complications of cytotoxic antineoplastic therapies and often require hospitalization with a severe economic impact. Furthermore, hematological toxicity frequently results in chemotherapy dose reductions and delays that could interfere with disease control.

Areas covered: This review provides an overview of granulocyte colony-stimulating factors (G-CSFs) including pegylated molecules, as well as more recent biosimilar G-CSFs, focusing on the toxicity, pharmacokinetics, and efficacy of these compounds.

Expert opinion: The administration of hematopoietic growth factors in primary and secondary prophylaxis of neutropenia is a standard supportive care measure. Recently, several biosimilars have been developed. The market for biosimilar agents seems to be increasing over time thanks to their similar effectiveness and safety, compared with their originators, but lower costs.

KEYWORDS:

• Balugrastim
• filgrastim
• granulocyte colony-stimulating factors
• lenograstim
• lipegfilgrastim
• pegfilgrastim

Article highlights

• Neutropenia and febrile neutropenia could be two severe complications in cancer patients receiving chemotherapy.

• Haematopoietic growth factors in primary and secondary prophylaxis of neutropenia is a standard supportive care measure.

• Filgrastim and lenograstim have a short elimination half-life (t ½) and require daily administrations. Pegfilgrastim and lipegfilgrastim have a longer half-life, and are administered once per cycle.

• Biosimilars are molecules very similar in efficacy, safety, and purity compared with their originators.

• Zarzio was the first FIL biosimilar approved by the FDA, with the same indications of the originator.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

One referee has received research funding from both reference (Amgen Inc, Roche, Janssen/Ortho-Biotech/Johnson & Johnson) and biosimilar manufacturers (Sandoz/Novartis, Teva Pharmaceuticals, Hospira/Pfizer, Coherus and Mylan) for growth factor ducts (GCSF and EPO/ESA). Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

The authors are financed by the Italian fiscal contribution ‘5x1000’ 2016 devolved to the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico.