Efficacy of pegfilgrastim to support neoadjuvant dose-dense epirubicin and cyclophosphamide chemotherapy in breast cancer

  • Xinguang Wang
  • Yingjian He
  • Tianfeng Wang
  • Yuntao Xie
  • Jinfeng Li
  • Tao Ouyang
  • Zhaoqing FanEmail author
Original Article



The role of long-acting hematopoietic growth factor in supporting dose-dense chemotherapy and minimizing hematologic toxicity has not been established. We investigated the efficacy and safety of once-per-cycle pegfilgrastim in breast cancer patients receiving neoadjuvant dose-dense epirubicin and cyclophosphamide (ddEC).


Newly diagnosed stage I to III breast cancer patients received four cycles of ddEC (E, 100 mg/m2 and C, 600 mg/m2 every 2 weeks) and 6 mg of subcutaneous pegfilgrastim on day 2 of each cycle. The primary endpoint was to evaluate the incidence of chemotherapy delay. Secondary endpoints include the incidences of febrile neutropenia (FN) and grade 3/4 neutropenia during the four ddEC cycles.


A total of 240 patients were enrolled and 913 ddEC cycles were administered in the study. Chemotherapy delay occurred in 15 patients (6.3% of patients, 95% CI 3.2–9.4%) for 17 cycles (1.9% of cycles, 95% CI 1.0–2.8%). The most frequent cause of chemotherapy delay was transaminase elevation (10 patients, 12 cycles). A total of 12 patients (5.0%, 95% CI 2.2–7.8%) developed 13 episodes of FN. Of the 221 patients that completed four ddEC cycles with pegfilgrastim support, 209 patients (94.6%, 95% CI 91.6–97.6%) had a 100% relative dose intensity (RDI). A RDI ≥ 85% was achieved in 217 of 221 patients (98.2%, 95% CI 96.5–99.9%). Bone pain of any grade was recorded in 85 of 220 evaluable patients (38.6%, 95% CI 32.2–45.0%).


Pegfilgrastim is effective and safe in facilitating four cycles of neoadjuvant ddEC, with low incidences of chemotherapy delay and febrile neutropenia.


Pegfilgrastim Febrile neutropenia Dose-dense chemotherapy Breast cancer 



This work was supported by CSPC Pharma by means of providing the pegfilgrastim used in the study. However, they were not involved in the collection, analysis, or interpretation of the data, nor in the decision to submit for publication. The corresponding author confirms that he had access to all data and had final responsibility for the decision to submit for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Xinguang Wang
    • 1
  • Yingjian He
    • 1
  • Tianfeng Wang
    • 1
  • Yuntao Xie
    • 1
  • Jinfeng Li
    • 1
  • Tao Ouyang
    • 1
  • Zhaoqing Fan
    • 1
    Email author
  1. 1.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Breast CenterPeking University Cancer Hospital & InstituteBeijingChina

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