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Once-Weekly Dosing of Epoetin-α Increases Hemoglobin and Improves Quality of Life in Anemic Cancer Patients Receiving Radiation Therapy Either Concomitantly or Sequentially with Chemotherapy

Authors: Shasha D, George MJ, Harrison LB
Source: Cancer, 2003;98:1072-9

Background

Materials and Methods

Results

Authors' Conclusions

Scientific Implications

Patients undergoing treatment for cancer with radiation therapy and chemotherapy often have anemia. This can cause profound fatigue with associated decreased quality of life, as pointed out by the authors. Anemia has also been shown to decrease cure rate in cervical and head and neck tumors. Therefore, it is imperative that anemia, especially severe anemia, be rectified. This study demonstrates that weekly epoetin-α can be used safely and efficaciously in this regard. However, this was a single arm, nonrandomized study in which several hundred of the patients were not evaluable for hemoglobin response or quality of life. Most were dropped because they did not meet the minimum radiation requirements, though this still could have skewed the data. Seventy four per cent of patients had a response to epoetin-α as measured by a 2 g/dl increase or a hemoglobin of > 12 g/dl with associated decrease in transfusion requirement and increase in quality of life. However, these parameters could be achieved at any point during the study, which was up to 16 weeks. Therefore, though the efficacy was high, its onset could have also been very slow. This is a large disadvantage in patient symptom relief and especially cancer treatment efficacy. Another aspect of the study not reported is cost. Epoetin-α is an expensive medication, especially if achieving efficacy means increasing the dose to 60,000 units per week. This should also be considered before initiating therapy. Therefore, although epoetin-α is efficacious and safe, it is often also slow in onset with a high expense. Transfusions increase the hemoglobin immediately and may be better in some patients. However, this increase in hemoglobin with transfusion may be short-lived. In addition, blood bank resources are finite, there is always the risk of infection or immunosuppression, and there is a cost associated with transfusion as well. Therefore, weekly administration of epoetin-α is a good alternative to transfusion, as long as the disadvantages are considered.


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