pegfilgrastim: clinical use

Prescribing considerations

• Initiate and supervise through clinicians experienced in oncology or haematology.
• The selected licences cover adults receiving cytotoxic chemotherapy for malignancy, excluding chronic myeloid leukaemia and myelodysplastic syndromes.
• Use caution in de novo acute myeloid leukaemia, sickle-cell disease or trait, and recent pulmonary infiltrates or pneumonia.
• Do not use to intensify chemotherapy beyond established regimens.
• Record the product name and batch number for biological traceability.
• Consider pegfilgrastim-related marrow activity when interpreting bone imaging.

Contraindications and cautions

• Hypersensitivity to pegfilgrastim or a formulation excipient.
• Do not re-expose after clinically significant pegfilgrastim hypersensitivity or pegfilgrastim-associated Stevens–Johnson syndrome.
• Avoid in patients with previous hypersensitivity to filgrastim.

Monitoring

• Full blood count, including white-cell and platelet counts, according to clinical context.
• Assess unexplained left upper abdominal or shoulder-tip pain for splenic enlargement or rupture.
• Monitor respiratory symptoms and investigate possible interstitial lung disease or ARDS.
• Urinalysis if kidney injury or glomerulonephritis is suspected.
• Monitor for capillary leak, sickle-cell crisis and large-vessel arteritis where clinically indicated.
• In breast or lung cancer treated with chemotherapy and/or radiotherapy, remain alert to features of MDS or AML.

Clinical pharmacology

Pegfilgrastim is recombinant human G-CSF conjugated to polyethylene glycol. It stimulates neutrophil production and release and has prolonged exposure because renal clearance is reduced; elimination is predominantly neutrophil-mediated and accelerates during neutrophil recovery.

Formulation and product differences

• Pelmeg and Neulasta are clear, colourless solutions in single-use pre-filled syringes containing sorbitol.
• Neulasta's needle cap contains a dry natural-rubber latex derivative; check latex allergy before use.
• Pelmeg is supplied with an automatic needle guard; Neulasta presentations may be supplied with or without one.
• Room-temperature storage limits and accidental-freezing allowances differ, so use the instructions for the brand supplied.
• Do not compare potency directly with other pegylated or non-pegylated proteins in the same therapeutic class.

Injection

Route: Parenteral

Strengths: 6 mg