Eflapegrastim versus Pegfilgrastim for Chemotherapy-Induced Neutropenia in Korean and Asian Patients with Early Breast Cancer: Results from the Two Phase III ADVANCE and RECOVER Studies

• Published in: Cancer research and treatment Vol. 55; no. 3; pp. 766 - 777
• Main Authors: Moon, Yong Wha, Kim, Seung Ki, Lee, Keun Seok, Lee, Moon Hee, Park, Yeon Hee, Park, Kyong Hwa, Kim, Gun Min, Lim, Seungtaek, Lee, Seung Ah, Choi, Jae Duk, Baek, Eunhye, Han, Hyesun, Baek, Seungjae, Im, Seock-Ah
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Cancer Association 01.07.2023; 대한암학회
• Subjects: Antineoplastic Agents - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Breast Neoplasms - drug therapy; East Asian People; Female; Filgrastim - therapeutic use; Granulocyte Colony-Stimulating Factor - therapeutic use; Humans; Neutropenia - chemically induced; Neutropenia - drug therapy; Original; Polyethylene Glycols; Republic of Korea; 의학일반; Republic of Korea; Breast neoplasms; Koreans; Asians; Long-acting granulocyte-colony stimulating factor; Neutropenia
• ISSN: 1598-2998; 2005-9256; 2005-9256
• DOI: 10.4143/crt.2022.987

Purpose We investigated the consistent efficacy and safety of eflapegrastim, a novel long-acting granulocyte-colony stimulating factor (G-CSF), in Koreans and Asians compared with the pooled population of two global phase 3 trials.Materials and Methods Two phase 3 trials (ADVANCE and RECOVER) evaluated the efficacy and safety of fixed-dose eflapegrastim (13.2 mg/0.6 mL [3.6 mg G-CSF equivalent]) compared to pegfilgrastim (6 mg based on G-CSF) in breast cancer patients who received neoadjuvant or adjuvant docetaxel/cyclophosphamide. The primary objective was to demonstrate non-inferiority of eflapegrastim compared to pegfilgrastim in mean duration of severe neutropenia (DSN) in cycle 1, in Korean and Asian subpopulations.Results Among a total of 643 patients randomized to eflapegrastim (n=314) or pegfilgrastim (n=329), 54 Asians (29 to eflapegrastim and 25 to pegfilgrastim) including 28 Koreans (14 to both eflapegrastim and pegfilgrastim) were enrolled. The primary endpoint, DSN in cycle 1 in the eflapegrastim arm was non-inferior to the pegfilgrastim arm in Koreans and Asians. The DSN difference between the eflapegrastim and pegfilgrastim arms was consistent across populations: –0.120 days (95% confidence interval [CI], –0.227 to –0.016), –0.288 (95% CI, –0.714 to 0.143), and –0.267 (95% CI, –0.697 to 0.110) for pooled population, Koreans and Asians, respectively. There were few treatment-related adverse events that caused discontinuation of eflapegrastim (1.9%) or pegfilgrastim (1.5%) in total and no notable trends or differences across patient populations.Conclusion This study may suggest that eflapegrastim showed non-inferior efficacy and similar safety compared to pegfilgrastim in Koreans and Asians, consistently with those of pooled population.