Efficacy and safety analysis of once per cycle pegfilgrastim and daily lenograstim in patients with breast cancer receiving adjuvant myelosuppressive chemotherapy FEC 100: a pilot study

Luigi Rossi,¹ Federica Tomao,² Giuseppe Lo Russo,¹ Anselmo Papa,¹ Federica Zoratto,¹ Raffaella Marzano,³ Enrico Basso,¹ Erika Giordani,¹ Monica Verrico,¹ Fabio Ricci,⁴ Giulia Pasciuti,⁵ Edoardo Francini,⁶ Silverio Tomao<sup>1

1</sup>Oncology Unit, ICOT Hospital, ²Department of Gynecology and Obstetrics, Policlinico Umberto I Hospital, University of Rome, ³Institute of Hematology and Blood Transfusion, ⁴Department of Surgery, S Maria Goretti Hospital, Latina, ⁵Oncology Unit, Don Luigi Liegro Hospital, Gaeta, ⁶Oncology Unit, Policlinico Umberto I Hospital, University of Rome, Italy

Background: Neutropenia is a common toxicity in patients receiving myelosuppressive chemotherapy. In this prospective pilot study, we compared the efficacy and safety profiles of pegfilgrastim administered subcutaneously once per cycle and lenograstim administered subcutaneously daily six times per cycle, for primary neutropenia prophylaxis in women with breast cancer receiving adjuvant anthracycline-based chemotherapy.
Materials and methods: Twenty women were enrolled. All patients received epirubicin 100 mg/m² with 5-fluorouracil 500 mg/m² and cyclophosphamide 500 mg/m² on day 1 and every 21 days thereafter, according to the FEC 100 chemotherapy regimen. Eight patients received a single dose of pegfilgrastim on day 2, while 12 patients were treated with daily administration of lenograstim from days five to ten. Absolute neutrophil count and duration of grade 3–4 neutropenia were monitored using seriated blood samples. The incidence of bone pain was evaluated using the visual analog scale (VAS).
Results: The incidence of grade 3–4 neutropenia was 75% in patients who received pegfilgrastim, and 25% in patients who received lenograstim. One case of febrile neutropenia was shown in pegfilgrastim patients. The mean duration of grade 3–4 neutropenia was 2 days in pegfilgrastim group versus 1.4 days in the lenograstim group. Bone pain was present in 37.5% of pegfilgrastim patients versus 58.3% of lenograstim patients. The mean duration of bone pain in the pegfilgrastim group was 4 days versus 6 days in the lenograstim group.
Conclusion: In our experience, a single injection of pegfilgrastim was less effective for controlling neutropenia than six daily injections of lenograstim. The safety profiles of pegfilgrastim and lenograstim were similar with a lower incidence of bone pain in patients treated with pegfilgrastim.

Keywords: lenograstim, pegfilgrastim, neutropenia, bone pain, breast cancer, adjuvant anthracycline-based chemotherapy