Armitage co-authors New England Journal of Medicine article

March 21, 2013

Image with caption: James Armitage, M.D.

James Armitage, M.D.

UNMC's James Armitage, M.D., has 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.

"These drugs have made a significant impact in the practice of medicine. However, in oncology they are still evolving."

James Armitage, M.D.

Dr. Armitage, the Joe Shapiro Professor of Internal Medicine in the UNMC Division of Oncology/Hematology co-authored the paper with 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.

Low white blood cell counts among cancer patients are typically treated with G-CSF or 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."

"This is a great illustration of what's wrong in the American health care system," said Dr. Bennett. "We simply cannot afford as a country to continue wasting billions of dollars on treatments that do nothing to improve the health of patients."

ASCO and the American Board of Internal Medicine have 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.

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