Journal of Oncology Pharmacy Practice - January 2022 - 5

Original Article
A retrospective review of the real-world
experience of the Pegfilgrastim
biosimilar (LapelgaVR
) to the
reference biologic (NeulastaVR
)
Gina Wong , Liying Zhang, Habeeb Majeed, Yasmeen Razvi,
Carlo DeAngelis, Emily Lam, Erin McKenzie, Katie Wang and
Mark Pasetka
Abstract
Introduction: Cancer patients receiving myelosuppressive chemotherapy are vulnerable to febrile neutropenia (FN)
which contributes to poor treatment outcomes. The use of granulocyte colony-stimulating factors is administered to
prevent chemotherapy-induced neutropenia. The introduction of biosimilars has allowed for greater cost-savings while
maintaining safety and efficacy. This retrospective study assessed the incidence of FN and related treatment outcomes
and the cost minimization of a pegfilgrastim biosimilar and its reference.
Methods: A retrospective chart review of breast cancer patients receiving (neo) adjuvant chemotherapy from February
2017 to May 2020 was conducted. The endpoints included the incidence of FN, the occurrence of dose reduction (DR),
dose delay (DD) and pain. A cost minimization analysis was performed from a third-party payer perspective.
Results: One hundred NeulastaVR
1 for NeulastaVR
three NeulastaVR
NeulastaVR
and 74 LapelgaVR
and LapelgaVR
cycles vs. 11 (3.5%) LapelgaVR
and 59 LapelgaVR
cycles vs 33 (10%) LapelgaVR
patients were included in the first-cycle analysis. The rate of FN in cycle
was 2/100 and 4/74, respectively; risk difference (RD) ¼ 3.4%; 95% CI: -2.4 to 9.2%. Eightypatients
were included in the all-cycle analyses, where DR was reported in 76 (15%)
cycles (RD¼-3.6, 95% CI: -10.2 to 2.9). DD was reported in 20 (4%) NeulastaVR
cycles (RD¼-0.3; 95% CI: -2.7 to 2.0). Adverse events were similar between groups. Cost
minimization using a cohort of 20,000 patients translated into an incremental savings of $21,606,800 CAD for each cycle.
Conclusion: The biosimilar pegfilgrastim was non-inferior to the reference biologic based on FN incidence in addition
to related outcomes including DR and DD.
Keywords
Febrile neutropenia, biosimilars, breast cancer, chemotherapy, myelosuppression, primary prophylaxis, granulocyte
colony-stimulating factors, pegfilgrastim, NeulastaVR
, LapelgaVR
Date received: 4 October 2020; revised: 25 October 2020; accepted: 26 October 2020
J Oncol Pharm Practice
! The Author(s) 2020
2022, Vol. 28(1) 5-16
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/1078155220974085
journals.sagepub.com/home/opp
Introduction
Febrile neutropenia (FN) is considered the most serious
dose-limiting toxicity of myelosuppressive chemotherapy,
as it both increases the immediate risk of
infection and limits the delivery of chemotherapy, leading
to suboptimal levels of long-term treatment success.1
It is often defined as an absolute neutrophil
count (ANC) less than 0.5 x 109 cells/L (or the expectation
that it will fall to <0.5 x 109 cells/L) with a single
oral temperature of38.3C or two consecutive readings
of38.0C for more than one or two hours.2,3 In
the acute setting, FN often results in emergency
hospitalization requiring antibiotic treatment to avoid
fatal consequences, including sepsis.4 Furthermore,
severe or prolonged neutropenia impacts the
Odette Cancer Centre, Sunnybrook Health Sciences Centre, University
of Toronto, Toronto, Ontario, Canada
Corresponding author:
Gina Wong, Care of Dr Mark Pasetka, Odette Cancer Centre,
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto,
Ontario M4N 3M5, Canada.
Email: gmywong@uwaterloo.ca

http://uk.sagepub.com/en-gb/journals-permissions http://dx.doi.org/10.1177/1078155220974085 http://journals.sagepub.com/home/opp https://www.orcid.org/0000-0002-5093-4181

Journal of Oncology Pharmacy Practice - January 2022

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