Erythropoietin Prevents Anemia and Reduces Transfusions in SCLC Patients

LUXEMBOURG-Home administration of erythropoietin (epoetin alfa,Epogen, Procrit) safely prevented or delayed the development ofchemotherapy-associated anemia and reduced transfusion requirementsby as much as 35% in a multicenter study of patients with small-celllung cancer (SCLC), Nicholas Thatcher, MD, said at the 7th InternationalSymposium of the Multinational Association of Supportive Carein Cancer (MASCC).

The 130 participants in this multicen-ter prevention trial fromthe Eprex Anemia Prevention Group all had normal hemoglobin levelsprior to their treatment with up to six cycles of intensive, mostlyplatinum-based chemotherapy, at 3- to 4-week intervals.

SCLC a Model System

They were randomized to receive no erythropoietin, or erythropoietinin a dose of 300 or 150 U/kg subcutaneously three times weekly,starting the day after chemotherapy and continuing until 3 daysbefore the next chemotherapy cycle.

"We can consider SCLC and its chemotherapy a model systemfor exploring the use of erythropoietin," said Dr. Thatcherof Christie Hospital, Manchester, UK. He told the symposium audiencethat even prior to chemotherapy, SCLC patients have significantlyfewer late and early erythroid progenitors in their bone marrowthan do subjects without malignant disease, and are thus especiallyvulnerable to anemia.

"By the second, third, fourth, and fifth chemotherapy cycles,"Dr. Thatcher said, "there was a significant reduction inthe percentage of patients who required transfusions, comparedwith the control group," he said.

Transfusions were necessary in 59% of control patients, but inonly 21% of those receiving 300 U/kg of erythropoietin, and in45% of those on the lower erythropoietin dose.

Dr. Thatcher emphasized that the mean hemoglobin level triggerfor transfusion was similar in all three patient groups, rangingfrom 8 to 8.6. In general, Dr. Thatcher said, candidates for erythropoietintherapy can be best identified on the basis of low pretreatmenthemoglobin levels or by a drop in hemoglobin levels after theyreceive the first cycle of chemotherapy.

"In my view, it may be reasonable to start off with the higherdose of ery-thropoietin and then titrate the dose down,"he advised.

Noting that 10% to 15% of patients in this study ended up withan iron deficiency, Dr. Thatcher also recommended that patientsbe given supplemental iron.