Is it safe to take Filgrastim (Granulocyte-Colony Stimulating Factor, G-CSF) with Capecitabine (Xeloda)?

From the Guidelines

It is generally acceptable to take filgrastim with capecitabine, as they are often used together in cancer treatment regimens to manage neutropenia and prevent infections. Filgrastim (Neupogen, Granix, Zarxio) is commonly prescribed alongside chemotherapy drugs like capecitabine to stimulate the bone marrow to produce more neutrophils (white blood cells), helping to prevent infections during chemotherapy treatment 1. The timing of filgrastim administration is important - it's typically given 24 hours after completing a chemotherapy cycle and continued daily until blood counts recover, usually for about 7-10 days 1.

Key Considerations

• Filgrastim works by stimulating the bone marrow to produce more neutrophils, helping to prevent infections during chemotherapy treatment 1.
• The specific schedule of filgrastim administration should be determined by your oncologist based on your treatment protocol, blood count monitoring, and individual risk factors 1.
• While these medications can be used together, you should always consult with your healthcare provider before combining any medications, as they will consider your complete medical history, current treatment plan, and potential drug interactions specific to your situation.

Administration Guidelines

• Use 5 µg/kg/day of G-CSF s.c. 24–72 h after the last day of chemotherapy until sufficient/stable ANC recovery (achieving a target ANC of >10 · 109/l is not necessary) 1.
• Pegfilgrastim, injected s.c. as a single dose of either 100 µg/kg (individualized) or of a total dose of 6 mg (general approach), is considered equally effective 1.

Important Notes

• G-CSF is contraindicated during radiotherapy to the chest due to increased rate of complications and death 1.
• Risk for severe thrombocytopenia when hGFs are given immediately before or simultaneously with chemotherapy 1.
• Possible risk of subsequent acute myeloid leukemia (AML) or myelodisplastic syndrome (MDS) in women receiving adjuvant chemotherapy for breast cancer and hGFs 1.

From the Research

Neutropenia and Filgrastim

• Filgrastim is a recombinant human granulocyte colony-stimulating factor (G-CSF) that stimulates the production of neutrophils 2.
• It is used to prevent neutropenia and febrile neutropenia in patients receiving chemotherapy, and has been shown to reduce the incidence, duration, and severity of neutropenia 2, 3.

Use of Filgrastim with Capecitabine

• There is no direct evidence in the provided studies on the use of filgrastim with capecitabine.
• However, filgrastim has been used to support the delivery of various chemotherapy regimens, including those that may be used in combination with capecitabine 3.
• The decision to use filgrastim with capecitabine would depend on the individual patient's risk factors for neutropenia and febrile neutropenia, as well as the specific chemotherapy regimen being used 4.

General Guidelines for Filgrastim Use

• Current guidelines recommend the use of filgrastim when the risk of febrile neutropenia is 20% or more, or when the risk is 10-20% and the patient has other risk factors for febrile neutropenia 3, 4.
• Filgrastim is generally well tolerated, with the most common adverse reaction being mild to moderate medullary bone pain 2.