5-fluorouracil + doxorubicin + leucovorin + cyclophosphamide + filgrastim

FLAC/G-CSF is a dose-intense chemotherapy regimen developed and evaluated by the National Cancer Institute (NCI) for the treatment of Stage II breast cancer. The regimen consists of four cytotoxic and modulating agents—5-fluorouracil, doxorubicin (Adriamycin), leucovorin, and cyclophosphamide (Cytoxan)—administered alongside granulocyte-colony stimulating factor (G-CSF, typically filgrastim). The cytotoxic components work synergistically to inhibit DNA synthesis and induce apoptosis in malignant cells, while leucovorin enhances the efficacy of 5-fluorouracil. The inclusion of G-CSF is critical to the "dose-intense" nature of the protocol, as it stimulates the production of neutrophils in the bone marrow, allowing for higher doses or more frequent administration of chemotherapy by reducing the duration and severity of treatment-induced neutropenia. Clinical studies, such as NCI-94-C-0169, have utilized this regimen to compare the outcomes of neoadjuvant (preoperative) versus adjuvant (postoperative) chemotherapy in breast cancer patients.

Other names

granulocyte-colony stimulating factor-National Cancer Institute (NCI)-breast cancerdose-intense FLAC/G-CSFpreoperative dose intense chemotherapy (FLAC/G-CSF)