Breast Cancer Coverage from Every Angle

Chemotherapy-Induced Neutropenia: Alternative Treatment Under Study in Early-Stage Breast Cancer

By: Joshua D. Madera, MS
Posted: Tuesday, November 17, 2020

For patients with early-stage breast cancer, the recombinant human granulocyte-colony stimulating factor analog eflapegrastim may prove to be an alternative therapeutic option to pegfilgrastim in reducing the risk for chemotherapy-induced neutropenia, according to the open-label phase III RECOVER trial published in Cancer Medicine. Eflapegrastim demonstrated noninferior efficacy and comparable safety at a lower dose as compared with pegfilgrastim, reported Lee S. Schwartzberg, MD, FACP, of the West Cancer Center, Germantown, Tennessee, and colleagues.

A total of 237 patients with stage I to IIIA early-stage breast cancer were recruited for the study. All patients were randomly assigned to one of two treatment regimens. Both groups were initially given standard docetaxel plus cyclophosphamide for four cycles. One day after each cycle, group A (n = 118) was administered 13.2 mg of fixed-dose eflapegrastim, and group B (n = 119) was administered 6 mg of pegfilgrastim.

The investigators reported that 20.3% of patients receiving eflapegrastim and 23.5% of patients receiving pegfilgrastim demonstrated severe neutropenia after the first cycle of docetaxel plus cyclophosphamide. The duration of severe neutropenia after the first cycle of docetaxel plus cyclophosphamide was noninferior in the eflapegrastim treatment group compared with the pegfilgrastim group. Of note, the noninferiority of eflapegrastim was maintained across all four cycles of docetaxel plus cyclophosphamide.

Furthermore, a comparison of the causality and grade of adverse effects did not reveal the same noninferiority trend between eflapegrastim (63%) and pegfilgrastim (61%). However, the incidence of severe adverse effects decreased with eflapegrastim (10%) compared with pegfilgrastim (16%).

“The potential for the increased potency of eflapegrastim to deliver improved clinical benefit warrants further clinical study,” commented Dr. Schwartzberg.

Disclosure: For full disclosures of the study authors, visit

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