Lipegfilgrastim is a medication used to reduce the duration of chemotherapy-induced neutropenia and incidence of febrile neutropenia in cytotoxic chemotherapy.

Generic Name
DrugBank Accession Number

Lipegfilgrastim, previously known as XM22, is a pegylated, recombinant granulocyte colony-stimulating factor (G-CSF) that was synthetized using a highly site-specific glycoPEGylation technology 2. It is used as an alternate to Pegfilgrastim for prophylactic use in cancer patients receiving chemotherapy and at risk for developing chemotherapy-induced neutropenia. Since July 2013, lipegfilgrastim is marketed by the EMA as Lonquex for subcutaneously injection, where it is administered once following cytotoxic chemotherapy for each chemotherapy cycle in adult patients being treated with cytotoxic chemotherapy for malignancy. It aims to reduce the duration of neutropenia and the incidence of febrile neutropenia.

Neutropenia and febrile neutropenia (FN) are frequent and potentially fatal complications that occur from myelosuppressive anticancer treatments 2. Severe chemotherapy-induced neutropenia and febrile neutropenia significantly increases the risk for life-threatening infection and sepsis. Granulocyte colony-stimulating factors (G-CSFs) were introduced in the 1980's to the clinical setting to stimulate neutrophil proliferation and differentiation, thereby reducing the duration and severity of chemotherapy-induced neutropenia 2. Lipegfilgrastim is a covalent conjugate of Filgrastim with a single methoxy polyethylene glycol (PEG) molecule via a carbohydrate linker consisting of glycine, N-acetylneuraminic acid and N-acetylgalactosamine 5. The average molecular mass of lipegfilgrastim comprises 18,798 Da for Filgrastim, 203 Da for GalNAc, 338 Da for glycylsialic acid and approximately 20,000 Da for PEG 6. PEG moiety protects the active molecule from enzyme degradation, which allows longer half-life of drug and less frequent dosing-schedule in addition to acceptable safety and efficacy profile 2.

Approved, Investigational
Biologic Classification
Protein Based Therapies
Other protein based therapies
Protein Structure
Protein Chemical Formula
Protein Average Weight
39000.0 Da (glycoPEGylated, approximate)
>Lipegfilgrastim sequence
Download FASTA Format
  • Lipegfilgrastim
External IDs
  • XM-22
  • XM22



Indicated for the reduction in the duration of neutropenia and the incidence of febrile neutropenia in adult patients treated with cytotoxic chemotherapy for malignancy (with the exception of chronic myeloid leukaemia and myelodysplastic syndromes) 5.

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Associated Conditions
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Mimicking endogenous granulocyte colony-stimulating factors, lipegfilgrastim enhances the number and function of circulating neutrophils by binding to endogenous G-CSF receptors. A small increase in monocyte and/or lymphocyte counts may also be observed 5. Following a single subcutaneous dose administration of 100 μg/kg, lipegfilgrastim resulted in a significant increase in neutrophilic granulocyte and large unstained cell counts 6. G-CSF also increases the antibacterial activities of neutrophils including the phagocytosis 5. Due to structural similarity between lipegfilgrastim and pegfilgrastim, G-CSF receptor binding was equivalent between two molecules 2. However, lipegfilgrastim showed greater time-dependent resistance to neutrophil elastase degradation and greater retention of activity than pegfilgrastim 2.

Mechanism of action

Endogenous granulocyte colony-stimulating factor (G-CSF) is a glycoprotein that stimulates neutrophil progenitors. It is produced mainly by monocytes, fibroblasts and endothelial cells to promote the development of neutrophils and increase their proliferation and maturation 4. Subsequently, G-SCF stimulates the release of matured neutrophils from the bone marrow storage pools into the peripheral blood to enhance their function 5,4. Via binding to to the human G-CSF receptors, lipegfilgrastim activates the receptor signalling pathway as a growth factor to stimulate proliferation of haematopoietic progenitor cells and their differentiation into mature cells, and promote subsequent release into the peripheral blood 5. This stimulatory effect of lipegfilgrastim may extend to other single lineage and multilineage progenitors and pluripotent haematopoietic stem cells 5. The presence of the PEG moiety in lipegfilgrastim decreases the plasma clearance and extends the drug's terminal elimination half-life, allowing for less frequent dosing 1.

AGranulocyte colony-stimulating factor receptor

In studies of healthy volunteers receiving a single subcutaneous injection of 6 mg of lipegfilgrastim, the peak plasma concentration of lipegfilgrastim was reached after a median of 30 to 36 hours 5. Based on its molecular weight, lipegfilgrastim is believed to be primarily absorbed via the lymphatic system then drained into the vascular system 7. Peak concentration and area under the curve, indicating full bioavailability, was lower in injection site of the thigh compared to subcutaneous injection in the abdomen and in the upper arm, with differences among the injection sites being the greatest in males compared to female subjects 5.

Volume of distribution

Lipegfilgrastim has a weight-dependent volume of distribution of 70 mL/kg, indicating minimal distribution beyond the lymphatic or vascular system 7.

Protein binding

Not Available


Lipegfilgrastim is metabolised via intra- or extracellular degradation by proteolytic enzymes 5. Following binding to the G-CSF receptors, it is proposed to be internalized by neutrophils via a non-linear process, and then undergoes degradation within the cell by endogenous proteolytic enzymes. Alternatively, the linear pathway is likely due to extracellular protein degradation by neutrophil elastase and other plasma proteases 5.

Route of elimination

Lipegfilgrastim undergoes two distinct clearance pathways: linear pathway composed of degradation by proteolytic enzymes and non-linear pathway involving neutrophil-mediated clearance 7. The elimination pathway by neutrophil-mediated clearance is saturated at higher doses 3. Lipegfilgrastim and its degraded fragments may undergo renal clearance 5.


The average terminal half-life ranged from approximately 32 to 62 hours after a single subcutaneous injection of 6 mg lipegfilgrastim in healthy individuals 5.


In a phase 1, multinational, open-label, single-arm study of paediatric patients with Ewing family of tumors or rhabdomyosarcoma treated with myelosuppressive chemotherapy, the mean apparent clearance (CL/F) was approximately 71 mL/h, 120 mL/h, and 116 mL/h for age groups of 2-6 years, 6-12 years, and 12-18 years, respectively 3.

Adverse Effects
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In safety pharmacological studies in rats and dogs, lipegfilgrastim was well tolerated at a single subcutaneous dose of 10 mg/kg. In the renal excretion study in rats, an intravenous dose of 250 μg/kg was well tolerated 6. While mutagenicity and genotoxicity studies have not been conducted with lipegfilgrastim, G-CSF has been reported to stimulate tumour growth and intratumoural vessel density in animal tumour models 6.

Not Available
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
AldesleukinAldesleukin may increase the myelosuppressive activities of Lipegfilgrastim.
AlemtuzumabAlemtuzumab may increase the myelosuppressive activities of Lipegfilgrastim.
AltretamineAltretamine may increase the myelosuppressive activities of Lipegfilgrastim.
AmsacrineAmsacrine may increase the myelosuppressive activities of Lipegfilgrastim.
Antihemophilic factor (recombinant), PEGylatedThe therapeutic efficacy of Lipegfilgrastim can be decreased when used in combination with Antihemophilic factor (recombinant), PEGylated.
Arsenic trioxideArsenic trioxide may increase the myelosuppressive activities of Lipegfilgrastim.
AzacitidineAzacitidine may increase the myelosuppressive activities of Lipegfilgrastim.
BelinostatBelinostat may increase the myelosuppressive activities of Lipegfilgrastim.
BendamustineBendamustine may increase the myelosuppressive activities of Lipegfilgrastim.
BexaroteneBexarotene may increase the myelosuppressive activities of Lipegfilgrastim.
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Food Interactions
No interactions found.


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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
LonquexInjection, solution6 mgSubcutaneousTeva B.V.2016-09-08Not applicableEU flag
LonquexInjection, solution6 mg/0.6mlSubcutaneousTeva B.V.2023-03-15Not applicableEU flag
LonquexInjection, solution6 mgSubcutaneousTeva B.V.2016-09-08Not applicableEU flag
LonquexInjection, solution6 mg/0.6mlSubcutaneousTeva B.V.2022-08-02Not applicableEU flag
LonquexInjection, solution6 mgSubcutaneousTeva B.V.2022-05-04Not applicableEU flag


ATC Codes
L03AA14 — Lipegfilgrastim
Drug Categories
Chemical TaxonomyProvided by Classyfire
Not Available
Organic Compounds
Super Class
Organic Acids
Carboxylic Acids and Derivatives
Sub Class
Amino Acids, Peptides, and Analogues
Direct Parent
Alternative Parents
Not Available
Not Available
Molecular Framework
Not Available
External Descriptors
Not Available
Affected organisms
Not Available

Chemical Identifiers

CAS number


General References
  1. Buchner A, Lammerich A, Abdolzade-Bavil A, Muller U, Bias P: Lipegfilgrastim: pharmacodynamics and pharmacokinetics for body-weight-adjusted and 6 mg fixed doses in two randomized studies in healthy volunteers. Curr Med Res Opin. 2014 Dec;30(12):2523-33. doi: 10.1185/03007995.2014.962131. Epub 2014 Sep 25. [Article]
  2. Guariglia R, Martorelli MC, Lerose R, Telesca D, Milella MR, Musto P: Lipegfilgrastim in the management of chemotherapy-induced neutropenia of cancer patients. Biologics. 2016 Jan 22;10:1-8. doi: 10.2147/BTT.S58597. eCollection 2016. [Article]
  3. Belogurova MB, Kizyma ZP, Garami M, Csoka M, Lamson MJ, Buchner A, Bias P, Lammerich A: A pharmacokinetic study of lipegfilgrastim in children with Ewing family of tumors or rhabdomyosarcoma. Cancer Chemother Pharmacol. 2017 Jan;79(1):155-164. doi: 10.1007/s00280-016-3216-2. Epub 2016 Dec 16. [Article]
  4. 25. (2012). In Rang and Dale's Pharmacology (7th ed., pp. 315). Edinburgh: Elsevier/Churchill Livingstone. [ISBN:978-0-7020-3471-8]
  5. European Medicines Agency (EMA) Summary of Product Characteristics: Lonquex (lipegfilgrastim) [Link]
  6. Australian Public Assessment Report for Lipefilgrastim (rbe) [Link]
  7. Therapeutic Goods Administration (TGA) product Information: Lonquex [Link]
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Clinical Trials

Clinical Trials
3CompletedTreatmentAggressive B Cell Non-Hodgkin Lymphomas at High Risk for R-CHOP-21-induced Neutropenia1
1CompletedOtherPharmacodynamics / Pharmacokinetics1
1CompletedSupportive CareEwing Family of Tumors, Rhabdomyosarcoma1
1, 2Unknown StatusTreatmentLymphoma / Multiple Myeloma (MM)1
Not AvailableCompletedNot AvailableBreast Cancer1


Not Available
Not Available
Dosage Forms
SolutionSubcutaneous6.000 mg
Injection, solutionIntramuscular; Subcutaneous6 MG
Injection, solutionParenteral; Subcutaneous6 MG
Injection, solutionSubcutaneous6 mg
Injection, solutionSubcutaneous6 mg/0.6ml
Injection, solutionSubcutaneous6.00 mg/0.6ml
Injection, solution10 mg/ml
Not Available
Not Available


Experimental Properties
Not Available


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Pharmacological action
General Function
Receptor activity
Specific Function
Receptor for granulocyte colony-stimulating factor (CSF3), essential for granulocytic maturation. Plays a crucial role in the proliferation, differientation and survival of cells along the neutroph...
Gene Name
Uniprot ID
Uniprot Name
Granulocyte colony-stimulating factor receptor
Molecular Weight
92155.615 Da

Drug created at June 23, 2017 20:37 / Updated at May 27, 2021 02:58