Real-World Use of Granulocyte-Colony Stimulating Factor in Patients with Breast Cancer from Alberta, Canada

SIMPLE SUMMARY: Most chemotherapy regimens used in the setting of non-metastatic breast cancer are myelosuppressive and are associated with toxicities with significant clinical implications, including febrile neutropenia. The use of granulocyte colony-stimulating factor (G-CSF) reduces the severity and duration of febrile neutropenia, following the initiation of myelosuppressive chemotherapy. The practice of G-CSF prophylaxis is a proven form of supportive care that is shifting with the introduction of biosimilars. As published data are limited, we characterized the patterns and predictors of G-CSF use in a large real-world Canadian cohort over an 11-year period. Our results demonstrate that G-CSF use can be further optimized to align with current guidelines and to improve supportive care for patients with breast cancer. ABSTRACT: Background: There are limited published data in the Canadian healthcare system on the use of granulocyte colony-stimulating factor (G-CSF) among patients with breast cancer. This study characterized real-world G-CSF use during the period surrounding the introduction of filgrastim biosimilar. Methods: Electronic medical records were reviewed retrospectively for patients with breast cancer who received moderately or highly myelosuppressive (neo)adjuvant chemotherapy from 2008 to 2019 in Alberta, Canada. Trends in G-CSF usage were plotted to elucidate temporal variations and multivariable regression models were constructed to identify clinical factors associated with G-CSF use. Results: We included 6662 patients in our analyses. G-CSF was used in 57.1% of patients during their treatment trajectory. Among the 3801 patients who were treated with G-CSF, the majority received pegfilgrastim only (91.5%; n = 3477) versus filgrastim only (5.7%; n = 217). G-CSF use increased linearly more than two-fold over the 11-year study period. Predictors of G-CSF use included younger age, south zone of residence, higher neighborhood education, inferior disease stage, highly neutropenic risk chemotherapy, and more recent chemotherapy initiation. Conclusions: Despite increasing G-CSF usage over time, an appreciable proportion of patients for whom G-CSF prophylaxis is recommended did not receive it. G-CSF use could be further optimized to align with supportive care clinical guidelines and reduce the impact of neutropenia and its associated complications.