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My daughter has been on crizotinib for a few weeks and each week her WBC and neutrophils count is dropping. I have been trying to find information if they give neulasta or neutrogen shots to raise them in order to continue treatment? This was the course when doing chemo, but I can not find anything when using a daily cancer drug and what they do when you have low counts. Do you have to stop the crizotinib until you retest blood work next week after receiving shots ot let blood rebuild naturally?
Thank you for any insight you can provide.
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Reply # - September 14, 2013, 04:47 AM
Reply To: Crizotinib and Neutropenia
One of the issues about crizotinib is that it is prescribed as a flat, single dose for all people. We know that for people who are smaller in build or body weight, it tends to cause more neutropenia, because the effective dose delivered is higher. So, it may be reasonable to discuss with your doctor about slightly changing the dose. This is more like tailoring the dose to the person. Usually we back the dose down to 200 mg twice daily, and if the neutropenia persists, additional dose changes can be made.
Repeated doses of neulasta have not been well-studied with crizotinib, and are usually not routinely recommended in this setting. Because of this, they may be unlikely to be covered by insurance in this situation. This is because the neutropenia is expected to persist unless a dose adjustment is made. It is simpler to back off slightly on one drug, than to add another. Hope this helps.
Reply # - October 17, 2013, 12:13 PM
Reply To: Crizotinib and Neutropenia
Has there been documented cases where Crizotinib has been effective for tumor shrinkage with taking a single dose of 250mg daily?
Reply # - October 17, 2013, 07:27 PM
Reply To: Crizotinib and Neutropenia
I don't know of anything published, but I happen to have seen a patient just today on whom I've needed to drop the dose to that level because of ongoing severe liver test abnormalities on higher doses but who is responding to 250 mg once daily.
-Dr. West
Reply # - June 17, 2014, 02:39 PM
Reply To: Crizotinib and Neutropenia
On the same line of this topic... My husband has been on Xalkori for almost 3 years now. His absolute lymphocyte counts have been trending down he was 0.8 for about a year, dropping to 0.6 over the last few months and labs today down to 0.4 with his overall WBC 3.2 and ANC 2.2. Is this a concern for dosing changes? He has very minimal side effects just occasional lower extremity edema and diarrhea. He has been progression free for almost 4 years (scan today) so we really don't want to change what is working! Has anyone else experienced lymphocytopenia?
Reply # - June 17, 2014, 06:57 PM
Reply To: Crizotinib and Neutropenia
Congratulations on such a nice, long benefit with XALKORI!
I have had occasional patients with cytopenias on XALKORI, sometimes requiring holding drug for a week here or there, then resuming it. The package insert actually says that it isn't necessary to change dosing of XALKORI for low lymphocyte counts except in the presence of "opportunistic" infections -- i.e., infections you don't normally get unless you're immunosuppressed.
-Dr. West