Study: drug given routinely during cancer treatment overused, ineffectiveThe drugs are routinely given to patients undergoing chemotherapy, but they only clinically benefit 10 percent of patients
A University of Nebraska Medical Center oncologist co-authored an article in the March 21 issue of the New England Journal of Medicine which determined the U.S. wastes an estimated $6 billion annually on popular white blood cell boosting drugs that have no medical benefits for most cancer patients using them.
The drugs, filgastrim or pegylated filgastim (commonly known as Neupogen or G-CSF, and Neulasta or peg G-CSF), are routinely given to patients undergoing chemotherapy, but they only clinically benefit 10 percent of patients receiving them -- elderly patients with multiple conditions. Ninety percent of patients who get the drugs, which can cost $3,000 per round, derive no clinical benefit.
Co-authors of the study were James Armitage, M.D., the Joe Shapiro Professor of Internal Medicine in the UNMC Division of Oncology/Hematology and Charlie Bennett, M.D., Ph.D., the Josie M. Fletcher Professor of Pharmacy of the University of South Carolina campus of the South Carolina College of Pharmacy. Drs. Bennett and Armitage are co-authors of the national guidelines on G-CSF and GM-CSF.
“These drugs have made a significant impact in the practice of medicine, however in oncology, they are still evolving as reflected in this article,” said Dr. Armitage, former president of the American Society of Clinical Oncology (ASCO) and internationally renowned lymphoma physician.
The study summarizes a large body of evidence about the drugs and confirms recent recommendations by ASCO and European experts that the drugs’ usage should be limited to a small subset of patients.
“This is a great illustration of what’s wrong in the American health care system. We simply cannot afford as a country to continue wasting billions of dollars on treatments that do nothing to improve the health of patients,” said Dr. Bennett.
Low white blood cell counts amongst cancer patients are typically treated with granulocyte colony-stimulating factor (G-CSF) or pegylated G-CSF (peg G-CSF).
Current guidelines indicate that the agents should only be used in settings where risks of low white blood cell counts causing infections are very high. However, current practice is to administer these agents to almost all patients who receive chemotherapy in an effort to be “better safe than sorry.”
ASCO has developed an initiative called “Choosing Wisely” in collaboration with the American Board of Internal Medicine. The initiative identified overuse of G-CSF and peg G-CSF as one of the five activities of oncologists that, if properly addressed, would both lower the health care costs of the country and also improve the well-being of cancer patients.
The researchers summarized a large body of evidence using a clinical case study which found that many patients have a low risk -- less than 20 percent -- of developing fevers and low white blood cell counts in the first place. For these patients, if they do not have other risk factors such as older age or other medical illnesses, treatment with G-CSF or peg G-CSF is not necessary, and is unlikely to improve their clinical course, or prevent infections and will greatly increase the cost of medical care.
Other contributors of the study included LeAnn Norris, an assistant professor at the South Carolina College of Pharmacy and Benjamin Djulbegovic, a professor at the University of South Florida.
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The South Carolina College of Pharmacy (SCCP) was formed in 2004 through the integration of the Colleges of Pharmacy at the University of South Carolina in Columbia (USC) and the Medical University of South Carolina in Charleston (MUSC). The SCCP is a statewide education, research and service institution that combines the nationally recognized faculty, staff and resources of MUSC, a major academic medical center; USC, a large comprehensive university; and Greenville Hospital System University Medical Center, a large progressive hospital system, to create a statewide approach to pharmacy education that is on par with some of the most highly regarded colleges in the United States.
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