Weekly Epoetin Alfa Boosts Energy and Activity Levels

SAN FRANCISCO—Anemic breast cancer patients receiving chemoradiotherapy who are also treated with weekly recombinant human erythropoietin (epoetin alfa [Procrit, Eprex, Erypo]) have not only better hemoglobin levels but also improved energy, activity levels, and overall quality of life.

According to a retrospective subgroup analysis, mean hemoglobin levels in treated patients increased from 10.1 g/dL at baseline to 12.6 g/dL, a mean change of 2.5 g/dL (P < 0.05). In patients with two or more quality-of-life assessments (n = 62), significant (P < 0.05) improvements from baseline to final assessment were observed.

Linda T. Vahdat, MD, told Oncology News International that the analysis showed that epoetin alfa was as effective in anemic breast cancer patients receiving both radiation and chemotherapy as had previously been observed in patients receiving chemotherapy alone. She said that similar results have been seen in patients with other types of cancer. Dr. Vahdat is with the Division of Medical Oncology, College of Physicians and Surgeons of Columbia University, New York City.

Monthly Self-Assessments

The breast cancer subgroup analysis was drawn from a multicenter, open-label, nonrandomized, 16-week study of epoetin alfa in patients with hemoglobin of 11 g/dL or less that were receiving concomitant or sequential radiation and chemotherapy. Monthly assessments included clinical response, hemoglobin levels, transfusion requirements, and incidence/severity of adverse events.

At baseline and at weeks 8 and 16, patient-reported energy, activity, and overall quality of life were measured by 100-mm Linear Analog Scale Assessment tool. The retrospective subanalysis included 64 evaluable patients with breast cancer. Of these, 51 (80%) received concomitant chemotherapy/radiotherapy and epoetin alfa. In 23 patients (36%), radiation was to the breast only, and 41 (64%) received radiation to the breast and to one or more other sites. Mean radiation dose to the primary site was 5,390 cGy (range: 2,880 to 6,600 cGy).

Hemoglobin Increases

Response was defined as a hemoglobin increase of 2 or more g/dL or attaining a hemoglobin level of at least 12 g/dL. The response rate was 91%. The researchers reported that 33% of patients required dose escalation from 40,000 U per week to 60,000 U per week.

Hemoglobin increases were independent of chemotherapy regimen, which included platinum-based regimens, taxane-based regimens, or doxorubicin/cyclophosphamide.

"I think the barriers to widespread use of epoetin alfa have slowly decreased and that hemoglobin maintenance is now becoming standard of care for management of breast cancer patients being treated with chemoradiation," Dr. Vahdat said.