Neulasta/neupogen
 

Hi everyone
I wonder if you can tell me if neulasta or neupogen are given routinely in the States as a preventative measure
during chemotherapy?
I am due to start docetaxol which my oncologist has told me killed two of her patients who developed neutropenia!!I also had neutropenia when I had AC and was quite poorly so am hoping and praying to avoid it this time round.
I have heard it is expensive and wondered if this might be a reason why it's not routinely given in the UK.
Grateful for any info
Ellie

It is not routinely given, only if your blood cell counts fall beneath a certain level. And yes, unfortunately it is expensive. Sending you hugs and hope Ellie, may you get great results this time.

I always got a neulasta shot the day following chemo.

Me too. it is routinely given to counteract the neutropenia that is expected with chemo. Why is your onc so negative and down right scary?

Thanks all for the information . I will speak to the onc about it especially in view of her comments.I am sure they don't give it routinely due to the rationing of resources going on in the NHS.Last time I had been hospitalised for 3 days before the physician agreed to give it to me as he told me it was very expensive! Ellie

According to my claims, the charges from my oncologist to the insurance company is about $7500 (US$) per shot. Yes it is an expensive little shot that takes them less than a minute to inject into my arm. I hope you will be able to get it.

Ellie,

Here in the States Neulasta is given the day following some chemo infusions. It is generally given with therapies that drop the white cell count appreciably and where there is not enough time between infusions for the counts to climb back up. With dose dense ACTH, which is administered every other week, Neulasta is given as there is not enough time for the WBC's to return to an acceptable level. With TCH it is on as needed basis depending on the white count, but is often not employed as there are 3 weeks between infusions and therefore time for the white count to rise.

I was delivered 2 syringes of Neulasta per month at a cost of $6000. The day following my infusion I self-administered one of the Neulasta syringes.

Hang in there, Ellie! This cancer stuff just absolutely blows!!!!!

Actually Laurel, I am on a TCH regimen, getting the TC every 3 weeks and I still get the neulasta the day after. My insurance company never questioned it.

Really? Good to know. I didn't think it was routine with TCH. I never had any problems with my insurance covering it either. How is neutropenia managed in the U.K., I wonder?

All are given Neulasta routinely as part of my oncol. protocol. She felt given preventatively was smart and kind. I liked her perspective toward the value of the drug ... not the cost.

AbbyDawg

In the UK to my knowledge it is given once neutropenia has developed and you are admitted to hospital. They tend to delay your chemo by a week if your blood level is low. This has happened to quite a number of other breast cancer patients I have spoken to.I have not found anyone who has had it as a preventative measure. This is such a shame as it just adds to the anxiety of having chemo.One lady I met at the breast clinic had not ventured out of her house and wouldn't have visitors as she was so frightened of getting an infection and becoming ill! Hugs Ellie

Yes, this really is a shame. Just one more reason for all of us to monitor what happens to the health care system in the U.S.

Elle,

You will get a white cell booster if your white cell count falls too low.

I needed a boost not only when I had dose dense AC, but also with Taxol. I gave myself preloaded shots in the thigh.

Joan

I don't think it is given routinely prophylactically unless warrented. After my first chemo my labs showed a big drop in the WBC so from then on neupogen was given routinely a few days after my chemo tx.

Neulasta/neupogen
 

I agree with Harrie.
I don't think it is given automatically. I think it depends on whether or not the results of the pre chemo blood test shows a below normal number of white blood cells.
Luckily I never needed Neulasta, Neupogen or Procrit.

Hi Ellie,

When I had Navelbine the first time, I was given Neupogen to take home and self adminster the shots in my abdomen for 4 days after every weekly treatment. that was 2 1/2 years ago. I am on Navelbine again, and even though I had to skip chemo a few weeks ago due to no neutrophils I was not given the shots to self administer. Instead, I had to go in every day for 4 days to receive a shot. It seems some Oncs give it as a preventative and others wait and see how your counts hold up. Since I have a history of low white counts I would assume that this Onc (up here where I live, or my local Onc) would give me the shots as a preventative, but he has decided to wait and see.
I just went in for a blood draw today and will know on Monday whether I will need some Neupogen. Since we are leaving for Las Vegas for a week on Monday, that could be a problem as I don't intend to stick around for a series of shots and cancel my vacation.
I know it is expensive but my insurance has never questioned it and has always paid.
I hope you will receive the Neupogen before your counts go too low.
Hang in there, sweet sister, you'll get through this.
Love, Vickie

Both WBC and RBC booster drugs are powerful, powerful drugs that act on your bone marrow.

They had never been routinely given until the dense dose 4 AC followed by 4 Taxol was accepted as standard of care in late 2003 (this is prior to Herceptin being added to the taxol part in mid 2005). The dense dose regime absolutely required a WBC booster - there was no way the white cells could recover in time as they could when the chemo was given every 3 weeks vs the dense dose's timing of every 2 wks.

Because oncs got used to using these drugs, they just use them even if you are not on a chemo that requires it.

If you are on a dense dose schedule, it is required. If you are not, perhaps a frank discussion with your onc and a second opinion is needed if you are just getting the shot without knowing if you actually need it.

If you need it, regardless, it is a drug that could be life saving (preventing horrendous infection) and that it keeps you on track in receiving your chemo treatments on time.

It is like anything, one doesn't take high blood pressure pills if you don't have high blood pressure so why take a WBC booster shot if your counts are adequate? These medications are not child's play.

so - did you get need neulasta/neupogen and did you recur?
 

Neulasta
 

Yes, I live in Upstate New York. It is standard to get a shot of neulasta the day after chemo to force quick production of your white blood cells , so you ca fight infection. It has the side affect of bone pain which lasted maybe 4 days. Hydrocodone was helpful on the most painful day. Other wise it was just lower back discomfort, almost like sciatica pain.

Neupogen can also have the side effect of bone ache. I had the bone pain only once and Advil took care of the discomfort nicely.