The purpose of this research study is to evaluate the safety and effectiveness of pegfilgrastim in reducing grade 3/4 neutropenia when given after one of three chemotherapy regimens (FOIL, FOLFOX or FOLFIRI) in patients with locally advanced or metastatic colorectal cancer. This study is considered to be "investigational" because the time between receiving pegfilgrastim and the next cycle of chemotherapy is only 11 days.

Inclusion Criteria:

• Locally advanced or metastatic colorectal adenocarcinoma not curable by surgery or amenable to radiation therapy with curative intent.
• Histologically or cytologically documented locally advanced or metastatic colorectal cancer. The site of the primary lesion must be or has been confirmed endoscopically, radiologically, or surgically to be or has been in the large bowel.
• Measurable or evaluable disease.
• ECOG performance status 0, 1 or 2
• Life expectancy ≥ 12 weeks
• All of the following: (1) ≥ 4 weeks must have elapsed from the time of major surgery and subjects must have recovered from the effects (e.g., laparotomy); (2) ≥ 2 weeks must have elapsed from the time of minor surgery and subjects must have recovered from the operation (insertion of a vascular access device is not considered major or minor surgery); (3) ≥ 4 weeks must have elapsed from the time of major radiotherapy (e.g., chest or bone palliative radiation therapy).
• Subjects may have received prior adjuvant therapy and one prior chemotherapy regimen for metastatic disease providing 30 days has elapsed from last chemotherapy dose.
• Subject must have recovered from prior chemotherapy complications and in the opinion of the investigator, the subjects current status does not place the subject at risk for entry into the trial.
• Subjects with prior exposure to both oxaliplatin and irinotecan will not be eligible to participate in this study. However, if subject received prior therapy with oxaliplatin, they will be eligible to receive the FOLFIRI regimen. If subject received prior therapy with irinotecan, they will be eligible to receive the FOLFOX regimen.
• Age ≥ 18 years
• Absolute neutrophil count ≥ 1.5 x 109/L
• Platelet count ≥100 x 109/L
• Hemoglobin ≥ 9.0 g/dL (subjects may be receive a red blood cell transfusion to achieve this requirement)
• Creatinine ≤ 1.5 x UNL
• Total bilirubin ≤ 1.5 mg/dL (≤ 25.65 μmol/L), regardless of whether subjects have liver involvement secondary to tumor
• Aspartate aminotransferase ≤ 5 x UNL
• Alkaline phosphatase ≤ 5 x UNL
• Informed consent to participate on the study.

Exclusion Criteria:

• Standard chemoradiation as adjuvant treatment for colorectal cancer will be allowed, but prior radiotherapy to >15% of bone marrow or outside of standard adjuvant colorectal cancer chemoradiation is not allowed.
• Known central nervous system metastases or carcinomatous meningitis.
• Predisposing colonic or small bowel disorders in which the symptoms are uncontrolled as indicated by baseline pattern of >3 loose stools daily in subjects without a colostomy or ileostomy. Subjects with a colostomy or ileostomy may be entered at the Investigator's discretion.
• Pleural effusion or ascites, which cause respiratory compromise (≥Grade 2 dyspnea).
• Concurrent use of other investigational agents.
• No active infection requiring the start of systemic (intravenous or oral) anti-infective (antibiotic, antifungal, antiviral) within 72 hours of the administration of the first cycle of study chemotherapy.
• Symptomatic sensory peripheral neuropathy.
• The following conditions: Uncontrolled high blood pressure; unstable angina; symptomatic congestive heart failure; myocardial infarction ≤ 6 months prior to randomization; serious uncontrolled cardiac arrhythmia; New York Heart Association classification III or IV.
• Prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, adequately treated noninvasive carcinomas, or other cancer from which the patient has been disease-free for at least five years.
• Interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the lung.
• Medical or psychiatric conditions which, in the opinion of the Investigator, make participation in an investigational trial of this nature a poor risk.
• Known sensitivity to E. coli derived products (e.g., Filgrastim, HUMULIN® insulin, L-asparaginase, HUMATROPE® Growth Hormone, INTRON® A) or known sensitivity to any of the products to be administered during dosing.
• Subject is currently enrolled or has not yet completed at least 30 days since ending other investigational device or drug trial(s) or is receiving other investigational agent(s).
• Subject of child-bearing potential is evidently pregnant (e.g., positive HCG test) or is breast feeding.
• Subject is not using adequate contraceptive precautions.
• Subject will not be available for follow-up assessment.
• Concerns for subject's compliance with the protocol procedures.

During treatment period and including 30 days after last dose of IP

The table of Other Adverse Events summarizes the most frequent non-serious occurrences of adverse events.

One subject randomized to pegfilgrastim arm was not summarized in the safety analysis set due to improper informed consent.

Another subject who was randomized to placebo arm but received pegfilgrastim and was summarized in pegfilgrastim arm.