***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Purpose Pegfilgrastim is a pegylated form of filgrastim , a recombinant protein of granulocyte colony-stimulating factor , that is used to reduce the risk of febrile neutropenia ( FN ) . Here , we report the results of a phase III trial of pegfilgrastim in breast cancer patients receiving docetaxel and cyclophosphamide ( TC ) chemotherapy .  Methods We conducted a double-blind , placebo-controlled , r and omized trial to determine the efficacy of pegfilgrastim in reducing the risk of FN in early-stage breast cancer patients . A total of 351 women ( 177 in the pegfilgrastim group and 174 in the placebo group ) between 20 and 69 years of age with stage I – III invasive breast carcinoma who were to receive TC chemotherapy ( docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2 every 3 weeks ) as either neoadjuvant or adjuvant therapy were enrolled ; 346 of these patients were treated with either pegfilgrastim ( n = 173 ) or placebo ( n = 173 ) . Results The incidence of FN was significantly lower in the pegfilgrastim group than in the placebo group ( 1.2 vs. 68.8 % , respectively ; P < 0.001 ) . In addition , patients in the pegfilgrastim group required less hospitalization and antibiotics for FN . Most adverse events were consistent with those expected for breast cancer subjects receiving TC chemotherapy . Conclusions Pegfilgrastim is safe and significantly reduces the incidence of FN in breast cancer patients Purpose Lipegfilgrastim is a once-per-cycle , fixed-dose , glycoPEGylated recombinant granulocyte colony-stimulating factor ( G-CSF ) recently approved in Europe to reduce the duration of chemotherapy-induced neutropenia and incidence of febrile neutropenia in patients with cancer receiving chemotherapy .  Bone pain-related ( BPR ) adverse events are commonly associated with G-CSF therapy . This post hoc analysis examined BPR treatment-emergent adverse events ( TEAEs ) in two comparative studies of lipegfilgrastim or pegfilgrastim in patients receiving chemotherapy .  Methods A post hoc analysis was conducted using integrated data from two double-blind r and omized studies in patients with breast cancer receiving docetaxel and doxorubicin  and treated prophylactically with subcutaneous lipegfilgrastim 6 mg or pegfilgrastim 6 mg once per cycle . BPR TEAEs were defined as arthralgia , back pain , bone pain , musculoskeletal chest pain , musculoskeletal discomfort , musculoskeletal pain , myalgia , neck pain , noncardiac chest pain , and pain in extremity . Relationship of BPR TEAEs to study treatment or chemotherapy was also reported by the investigators . Results The analysis included 306 patients ( lipegfilgrastim : n = 151 ; pegfilgrastim : n = 155 ) . The proportion of patients experiencing BPR TEAEs was similar with lipegfilgrastim and pegfilgrastim ( 25.2 vs 21.9 % , respectively ) , as was the proportion of patients experiencing BPR treatment-emergent adverse drug reactions ( TEADRs ) ( 18.5 vs 16.8 % , respectively ) . No BPR TEADRs were serious , and none led to discontinuation . Conclusions Nonsevere BPR TEAEs and TEADRs were observed in patients with breast cancer receiving chemotherapy and G-CSF ; rates of BPR events were similar between lipegfilgrastim and pegfilgrastim . The similar BPR safety profile of lipegfilgrastim and pegfilgrastim provides support for use in patients with breast cancer receiving chemotherapy After informed consent , 86 patients with advanced cancer undergoing potentially myelosuppressive cytotoxic chemotherapy  were r and omized to receive placebo or subcutaneous granulocyte-colony stimulating factor ( G-CSF ) 5 micrograms/Kg/day in order to prevent severe neutropenia and its related morbidity . The incidence of neutropenia ( absolute neutrophil count < 1,000/mm3 ) was significantly reduced in patients receiving G-CSF than in controls ( 18 % versus 42 % ; P < 0.05 ) . The duration of neutropenia was also shortened by the administration of G-CSF ( 4.8 versus 8.2 days ; P < 0.05 ) . Therapy with G-CSF has also a positive impact on the dose-intensity of employed regimens . Patients treated with G-CSF showed oral fungal disease in 9 % of cases , while control patients had a 21 % incidence ( NS ) . Patients treated with G-CSF received 91 % of the programmed dose-intensity as compared to 71 % of control patients ( P < 0.05 ) . These data strengthen the clinical usefulness of G-CSF in the prevention of chemotherapy-related neutropenia , infections , and reduction in dose-intensity . Further studies are required to establish if the increase in dose-intensity allowed by G-CSF treatment may positively influence the outcome of cancer patients Background Patients with acute myeloid leukemia ( AML ) are often neutropenic as a result of their disease . Furthermore , these patients typically experience profound neutropenia following induction and /or consolidation chemotherapy and this may result in serious , potentially life-threatening , infection . This r and omized , double-blind , phase 2 clinical trial compared the efficacy and tolerability of pegfilgrastim with filgrastim for assisting neutrophil recovery following induction and consolidation chemotherapy for de novo AML in patients with low-to-intermediate risk cytogenetics . Methods Patients ( n = 84 ) received one or two courses of  st and ard induction chemotherapy ( idarubicin + cytarabine ) , followed by one course of consolidation therapy ( high-dose cytarabine ) if complete remission was achieved . They were r and omized to receive either single-dose pegfilgrastim 6 mg or daily filgrastim 5 μg/kg , beginning 24 hours after induction and consolidation chemotherapy . Results The median time to recovery from severe neutropenia was 22.0 days for both pegfilgrastim ( n = 42 ) and filgrastim ( n = 41 ) groups during Induction 1 ( difference 0.0 days ; 95 % CI : -1.9 to 1.9 ) . During Consolidation , recovery occurred after a median of 17.0 days for pegfilgrastim versus 16.5 days for filgrastim ( difference 0.5 days ; 95 % CI : -1.1 to 2.1 ) . Therapeutic pegfilgrastim serum concentrations were maintained throughout neutropenia . Pegfilgrastim was well tolerated , with an adverse event profile similar to that of filgrastim . Conclusion These data suggest no clinical ly meaningful difference between a single dose of pegfilgrastim and multiple daily doses of filgrastim for shortening the duration of severe neutropenia following chemotherapy in de novo AML patients with low-to-intermediate risk cytogenetics . Trial registration Clinical trials.gov BACKGROUND Neutropenia is common in patients receiving myelotoxic chemotherapy .  Pegfilgrastim , a sustained- duration filgrastim is a once-per-cycle therapy for prophylactic neutrophil support . PATIENTS AND METHODS Women , treated with four cycles of doxorubicin/docetaxel chemotherapy every 21 days , received pegfilgrastim or filgrastim 24 h after chemotherapy as a single subcutaneous injection per chemotherapy cycle ( pegfilgrastim 30 , 60 or 100 microg/kg ) or daily subcutaneous injections ( filgrastim 5 microg/kg/day ) . Safety , efficacy and pharmacokinetics were analyzed . RESULTS The incidence of grade 4 neutropenia in cycle 1 was 95 , 90 and 74 % , in patients who received pegfilgrastim 30 , 60 and 100 microg/kg , respectively , and 76 % in patients who received filgrastim .  Mean duration of grade 4 neutropenia in cycle 1 was 2.7,2 and 1.3 days for doses of pegfilgrastim , and 1.6 days for filgrastim . The pharmacokinetics of pegfilgrastim were non-linear and dependent on both dose and neutrophil count . Pegfilgrastim  serum concentration was sustained until the neutrophil nadir occurred then declined rapidly as neutrophils started to recover , consistent with a self-regulating neutrophil-mediated clearance mechanism . The safety profiles of pegfilgrastim and filgrastim were similar . CONCLUSIONS A single subcutaneous injection of pegfilgrastim 100 microg/kg provided neutrophil support and a safety profile comparable to daily subcutaneous injections of filgrastim during multiple chemotherapy cycles Sepsis associated with neutropenia remains a major cause of morbidity and mortality from many chemotherapy regimens . In a recent tabulation of commonly used chemotherapy agents [ 1 ] , 29 of 37 are listed as causing marked or moderate leukopenia . A known correlation exists between the degree and duration of neutropenia and the risk for sepsis [ 2 ] . In conjunction with neutropenia , infections with gram-negative organisms such as Pseudomonas spp . occur relatively frequently and have high morbidity and mortality rates if antibiotic therapy is not begun until infection is microbiologically confirmed [ 3 , 4 ] . Current recommended practice is to initiate empiric , broad-spectrum intravenous antibiotic therapy in all patients with febrile neutropenia at the onset of fever , despite clinical and microbiological evidence of infection being found in only 40 % to 60 % of cases [ 5 ] . In addition to antibiotic therapy , neutrophil recovery is an important factor for a successful treatment outcome in these patients [ 6 , 7 ] and has been identified as the most favorable prognostic factor in a recent multivariate logistic regression analysis of 14 variables analyzed in a study of antibiotic efficacy [ 7 ] . Granulocyte transfusions are logistically difficult , are associated with substantial toxicity , and are of uncertain efficacy [ 8 , 9 ] ; before the availability of the colony-stimulating factors , few pharmacologic agents had clinical utility in increasing neutrophil levels [ 10 ] . Filgrastim ( previously known as recombinant methionyl human granulocyte colony-stimulating factor [ r-metHuG-CSF ] ) is a hematopoietic growth factor that promotes the survival , proliferation , differentiation , and function of progenitor and mature cells of the neutrophil granulocyte lineage [ 11 ] . It has potent granulopoietic effects in vivo [ 12 - 14 ] , and its clinical pharmacology has been defined [ 15 ] . In two phase III studies [ 16 , 17 ] , filgrastim therapy that was started 1 day after chemotherapy reduced the severity and duration of neutropenia and decreased by nearly half the incidence of febrile neutropenic episodes and the average duration of hospitalization and antibiotic use per patient . The use of filgrastim to prevent febrile neutropenic episodes in patients with cancer who receive chemotherapy is now an approved indication in many countries . Not all patients with cancer who have had chemotherapy and who have been treated with  filgrastim receive it to reduce the risk for neutropenic sepsis . Approximately 14 % of filgrastim in the United States has been used to treat episodes of postchemotherapy febrile neutropenia after they occur rather than to prevent them ( unpublished market research data , Amgen , Inc. ) . To determine if filgrastim administered in addition to st and ard empiric inpatient antibiotic therapy was also beneficial in patients presenting with established fever and neutropenia , we conducted a multicenter , r and omized , double-blind , placebo-controlled study . This is the first report of a study assessing therapeutic intervention with filgrastim in this clinical setting . Methods We present the analysis of findings from 218 patients enrolled at four centers between October 1988 and February 1992 . The study drug was filgrastim , a recombinant human protein produced in Escherichia coli [ 18 ] and supplied by Amgen , Inc. , Thous and Oaks , California . Patients Eligible patients with febrile neutropenia were adults ( age 16 years ) receiving chemotherapy for histologically confirmed cancer other than myeloid leukemia who had an oral temperature of greater than 38.2 C and a neutrophil count less than 1.0 109/L. The neutrophil count included the number of b and s and polymorphonuclear forms counted in manual differentials from blood smears . Patients were ineligible if they were already receiving antibiotic therapy , if they had septic shock ( a systolic blood pressure of < 90 mm Hg , poor peripheral perfusion , and abnormal mentation ) , if they were receiving myeloablative chemotherapy with marrow transplantation support , if they had severe renal impairment ( serum creatinine level > 0.7 mM ) , abnormal liver function ( bilirubin > 5 times the upper limit of normal ) , were pregnant or breast-feeding , or had a history of allergic reactions to the study antibiotics . Patients could enter the r and omized trial only once . If subsequent episodes of fever and neutropenia developed , patients were offered open-label filgrastim therapy 
    Output:
    
Mecapegfilgrastim , lipegfilgrastim and balugrastim might be the most appreciate G-CSF drugs with both good efficacy and tolerability when treating cancer patients after cytotoxic chemotherapy