Vol.:(0123456789) 1 3 International Journal of Clinical Pharmacy https://doi.org/10.1007/s11096-018-0667-z SHORT RESEARCH REPORT Optimal timing for pegflgrastim administration in Japanese breast cancer patients receiving intermediate‑risk chemotherapies Tatsuya Hayama 1,2  · Kenichi Sakurai 3  · Katsuhiro Miura 2,4  · Shinsaku Washinosu 1  · Shinya Tsuboi 1,2  · Akihiro Uchiike 1,2  · Yoshikazu Yoshida 1  · Masami Takei 4 Received: 22 January 2018 / Accepted: 24 May 2018 © Springer International Publishing AG, part of Springer Nature 2018 Abstract Background Pegflgrastim is widely used for prophylaxis of febrile neutropenia (FN) in cancer patients receiving chemo- therapies. However, the optimal timing of pegflgrastim administration has not been established. Objective We investigated the efect of the timing of pegflgrastim administration on the prevention of FN in patients with breast cancer undergoing intermediate-risk chemotherapies. Method We retrospectively analysed the incidence of FN in patients with breast cancer treated at our institution with intermediate-risk chemotherapies and primary or secondary prophylactic pegflgrastim between 2015 and 2017. The impact of the timing of pegflgrastim administration on the incidence of FN was evaluated by univari- ate and multivariate logistic regression analyses. Results Overall, 87 patients received a total of 318 chemotherapy cycles with pegflgrastim, and 14 patients (16%) experienced FN. In univariate analyses, day 2 pegflgrastim administration, age of > 65 years, baseline haemoglobin < 12 g/dL, prior history of FN, and presence of recurrent/metastatic disease trended toward an association with FN. Adjustment for these confounding risk factors revealed that day 2 pegflgrastim administra- tion was associated with a signifcantly increased risk of FN (odds ratio 11.0, p = 0.009). Conclusion Administrating pegfl- grastim on day 3 or later may prevent FN more efectively among Japanese breast cancer patients receiving intermediate-risk chemotherapies. Keywords Breast cancer · Febrile neutropenia · Intermediate-risk chemotherapies · Pegflgrastim Impacts on practice • Oncologists could treat patients with breast cancer receiving intermediate-risk chemotherapies more efec- tively by avoiding early administration of pegflgrastim on day two. • Administrating pegflgrastim on day three or four may prevent unnecessary use of intravenous antibiotics and hospitalization among these patients. Introduction Granulocyte-colony stimulating factors (G-CSFs) have a proven beneft in preventing febrile neutropenia (FN). Primary prophylaxis using G-CSFs (i.e., administrating G-CSFs during the frst and subsequent cycles) is recom- mended for patients receiving chemotherapy with ≥ 20% risk of FN [1], or patients who are receiving “intermediate-risk” Tatsuya Hayama, Kenichi Sakurai and Katsuhiro Miura have contributed equally to this work. * Katsuhiro Miura miura.katsuhiro@nihon-u.ac.jp 1 Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, Japan 2 Tumor Center, Nihon University Itabashi Hospital, 30-1 Oyaguchikamicho, Itabashi ward, Tokyo 173-8610, Japan 3 Departments of Breast and Endocrine Surgery, Nihon University School of Medicine, Tokyo, Japan 4 Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan