Pegfilgrastim-Induced Bone Pain: A Review on Incidence, Risk Factors, and Evidence-Based Management

Moore, Donald C; Pellegrino, A

doi:10.1177/1060028017706373

Cited by 24 publications

(17 citation statements)

References 26 publications

(51 reference statements)

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“…2A). Previous reports have shown that repeated Peg G administration caused severe adverse events specific to Peg G, such as spontaneous splenic rupture (33), musculoskeletal pain (34-38), and interstitial pneumonia. These severe adverse effects were not observed in the Peg G group in this study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Safety and Efficacy of Secondary Prophylactic Pegylated G-CSF in Advanced Pancreatic Cancer Patients Treated with mFOLFIRINOX: A Single-center Retrospective Study

et al. 2019

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Objective Although modified FOLFIRINOX (mFOLFIRINOX, mFFX) is widely used for patients with advanced pancreatic ductal adenocarcinoma (PDAC), maintenance of the standard dose intensity is often difficult due to the high incidence of neutropenic events. Pegylated granulocyte colony-stimulating factor (G-CSF) (Peg G) is a long-lasting G-CSF agent that is applicable for prophylaxis against neutropenic complications. The aim of this study was to assess the clinical safety and efficacy of mFFX combined with secondary prophylaxis using Peg G in advanced PDAC patients. Methods Advanced PDAC patients who had received more than two cycles of mFFX were analyzed. The clinical safety and efficacy were compared between patients in the Peg G group and those in the non-Peg G group in a retrospective manner. Results Among 45 patients treated with mFFX, 28 exhibited grade 3-4 neutropenia or febrile neutropenia. Among these 28 patients, 4 who received only 1 or 2 mFFX cycles were excluded from this study. Finally, 11 patients in the Peg G group and 13 in the non-Peg G group were enrolled. The combination therapy with Peg G and mFFX markedly prolonged the progression-free survival compared with the non-Peg G group, and its effects were associated with a reduced incidence of neutropenic events as well as lower rates of dosage reduction, delayed chemotherapy due to neutropenic events and altered blood cell counts after chemotherapy. Conclusion The scheduled administration of secondary prophylactic Peg G prolonged the progression-free survival in patients treated with mFFX. The combination therapy of Peg G and mFFX may be recommended in patients who exhibit grade 3-4 neutropenic events after prior mFFX cycles.

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Section: Discussionmentioning

confidence: 99%

Clinical Safety and Efficacy of Secondary Prophylactic Pegylated G-CSF in Advanced Pancreatic Cancer Patients Treated with mFOLFIRINOX: A Single-center Retrospective Study

et al. 2019

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“…Loratadine, an antihistamine, is currently the most investigated drug for the treatment of cancer-induced bone pain. In patients with bone metastases, treatment with pegfilgrastim, a complementary drug that stimulates the production of neutrophils, causes severe pain [ 70 - 72 ]. Several clinical trials have analyzed the effect of loratadine for the prevention of pain in patients previously treated with pegfilgrastim.…”

Section: Novel Strategies For Neuropharma- Cological Management Of Bone Tumor Painmentioning

confidence: 99%

Neurophysiological Mechanisms Related to Pain Management in Bone Tumors

Romero-Morelos

Ruvalcaba-Paredes

Garciadiego-Cázares

et al. 2021

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Background: Primary and metastatic bone tumor incidence has increased in the last years. Pain is a common symptom and is one of the most important related factor to the decrease of quality of life in these patients. Different pain management strategies are not completely effective and many patients afflicted by cancer pain cannot be controlled properly. In this sense we need to elucidate the neurophysiology of cancer-induced pain contemplating other quality of life components such as inflammation, neuropathies and cognitive components regarding bone tumors, and thus pave the way for novel therapeutic approaches in this field. Aim: Identify the neurophysiology of the mechanisms related to pain management in bone tumors. Method: Advanced searches were performed in scientific databases: PubMed, ProQuest, EBSCO, and the Science Citation index to get information about the neurophysiology mechanisms related to pain management in bone tumors. Results: The central and peripheral mechanisms that promote bone cancer pain are poorly understood. Studies have shown that bone cancer could be related to neurochemicals produced by tumor and inflammatory cells, coupled with peripheral sensitization due to nerve compression and injury caused by tumor growth. Activity of mesolimbic dopaminergic neurons, substance P, cysteine/glutamate antiporter, and other neurochemical dynamic’s brings us putative strategies to suggest better and efficient treatments against pain in cancer patients. Conclusion: Cancer-induced bone pain could include neuropathic and inflammatory pain, but with different modifications to the periphery tissue, nerves and neurochemical changes in different neurological levels. In this sense, here we explore opportunity areas in pharmacological and non-pharmacological pain management, according to pain-involved mechanisms.

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“…Recombinant G-CSF filgrastim and lenograstim are clinically used for neutrophil regeneration after chemotherapy or myeloablation [644]. Adverse effects include inflammation, swelling, pain, and stinging; the most common adverse effect of pegfilgrastim and lenograstim is bone pain [645,646]. In addition, there seems to be a role for microglia in G-CSF-driven neuronal hyperexcitability [647].…”

Section: Colony-stimulating Factorsmentioning

confidence: 99%

Novel Analgesics with Peripheral Targets

Ciotu

Fischer

2020

Neurotherapeutics

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A limited number of peripheral targets generate pain. Inflammatory mediators can sensitize these. The review addresses targets acting exclusively or predominantly on sensory neurons, mediators involved in inflammation targeting sensory neurons, and mediators involved in a more general inflammatory process, of which an analgesic effect secondary to an anti-inflammatory effect can be expected. Different approaches to address these systems are discussed, including scavenging proinflammatory mediators, applying anti-inflammatory mediators, and inhibiting proinflammatory or facilitating anti-inflammatory receptors. New approaches are contrasted to established ones; the current stage of progress is mentioned, in particular considering whether there is data from a molecular and cellular level, from animals, or from human trials, including an early stage after a market release. An overview of publication activity is presented, considering a IuPhar/BPS-curated list of targets with restriction to pain-related publications, which was also used to identify topics.

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Pegfilgrastim-Induced Bone Pain: A Review on Incidence, Risk Factors, and Evidence-Based Management

Abstract: Naproxen is effective at managing PIBP. Although commonly used, antihistamines have a paucity of data supporting their use. Dose reductions of pegfilgrastim and opioids may also be potential management options; however, data supporting these treatment modalities are scarce.

Cited by 24 publications

References 26 publications

Clinical Safety and Efficacy of Secondary Prophylactic Pegylated G-CSF in Advanced Pancreatic Cancer Patients Treated with mFOLFIRINOX: A Single-center Retrospective Study

Clinical Safety and Efficacy of Secondary Prophylactic Pegylated G-CSF in Advanced Pancreatic Cancer Patients Treated with mFOLFIRINOX: A Single-center Retrospective Study

Neurophysiological Mechanisms Related to Pain Management in Bone Tumors

Novel Analgesics with Peripheral Targets

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