Lipegfilgrastim

How it works

It binds to G-CSF receptors on myeloid progenitor cells, stimulating proliferation, differentiation and functional activation of neutrophils, with pegylation prolonging its half-life to allow once-per-cycle dosing.

Prescribing in practice

• Rare but serious splenic rupture, capillary leak syndrome and acute respiratory distress syndrome have been reported; advise patients to report upper-left abdominal or shoulder-tip pain urgently.
• It should not be given in the period spanning the days immediately before and after cytotoxic chemotherapy; follow the SPC for timing relative to the chemotherapy cycle.
• Sickle cell crises have been reported in patients with sickle cell disease or trait, so use with caution in this group.

Monitoring

Monitor the full blood count regularly during therapy, watching in particular for leucocytosis and the platelet count.

Counselling the patient

• Bone pain is a common side effect and can usually be managed with simple analgesia.
• Report sudden severe upper abdominal or left shoulder pain, breathlessness or signs of allergy promptly.

Evidence & guidelines

Use of G-CSF for chemotherapy-induced neutropenia is supported by NICE cancer guidance and established oncology practice.