What counseling approach is recommended for a patient with an unspecified medical condition?

Counseling on Lapelga®

Overview and Patient Education

Lapelga® is a pegfilgrastim biosimilar used to prevent febrile neutropenia during chemotherapy, and patients should be counseled on its administration schedule, expected side effects, and when to seek immediate medical attention. 1

Key Counseling Points for Patients

Administration and Timing

• Lapelga® is administered as a single subcutaneous injection once per chemotherapy cycle, typically 24-72 hours after chemotherapy completion 1
• The medication works by stimulating white blood cell production to prevent serious infections during chemotherapy 1
• Patients should understand this is primary prophylaxis - meaning it prevents infection before it occurs, not treats existing infection 1

Expected Side Effects and Management

The most common side effects patients should anticipate include:

• Musculoskeletal pain (bone pain, particularly in the back, hips, and legs) - occurs as the bone marrow increases white blood cell production 1
• Fever (without infection) - can occur as a medication effect 1
• Headache 1

Important reassurance: In real-world data, 88.6% of patients reported no side effects specifically attributed to Lapelga® 1

Pain Management Strategies

• Over-the-counter acetaminophen or NSAIDs can be used for bone pain (confirm no contraindications with oncologist) 1
• Pain typically peaks 2-3 days after injection and resolves within several days 1
• Staying well-hydrated may help reduce discomfort 1

Critical Warning Signs Requiring Immediate Medical Attention

Patients must contact their oncology team or go to the emergency department immediately if they develop:

• Fever ≥38°C (100.4°F) - this could indicate febrile neutropenia despite prophylaxis 1
• Chills or rigors 1
• Signs of infection (cough, burning with urination, unusual discharge, redness/warmth at any site) 1
• Severe or persistent bone pain unrelieved by over-the-counter medications 1

Febrile Neutropenia Risk Context

• With Lapelga® prophylaxis, the risk of febrile neutropenia is only 3.48% in breast cancer patients receiving adjuvant chemotherapy 1
• All patients who developed febrile neutropenia in clinical experience recovered completely with hospitalization and supportive care 1
• No mortality has been reported with Lapelga® use in the real-world setting 1

Efficacy and Safety Profile

Proven Effectiveness

• Lapelga® has demonstrated effective prevention of febrile neutropenia across common chemotherapy regimens including:
  • Dose-dense AC-Paclitaxel (adriamycin and cyclophosphamide followed by paclitaxel) 1
  • TC (docetaxel and cyclophosphamide) 1
  • FEC-D (5-fluorouracil, epirubicin, cyclophosphamide, and docetaxel) 1

Safety Record

• No cases requiring switch to alternative growth factors have been documented 1
• The medication is fully reimbursed under the Ontario Drug Benefit program and remains the most commonly used biosimilar in this category 1

Practical Considerations

Injection Site Care

• Injection sites should be rotated (abdomen, thigh, or upper arm) 1
• Avoid injecting into areas that are tender, red, bruised, or scarred 1
• Apply gentle pressure after injection; do not rub the site 1

Lifestyle During Treatment

• Maintain good hand hygiene to reduce infection risk 1
• Avoid crowds and people with active infections when possible 1
• Report any new symptoms promptly to the oncology team 1

Common Pitfalls to Avoid

• Do not delay seeking care for fever - even with prophylaxis, breakthrough febrile neutropenia requires immediate evaluation and hospitalization 1
• Do not assume bone pain means the medication isn't working - this is an expected effect of successful white blood cell stimulation 1
• Do not skip doses - consistent prophylaxis throughout chemotherapy is essential for optimal protection 1