DURHAM, North CarolinaImproving quality of life for cancer patients is
the driving force behind clinical patterns of use of erythropoietin (EPO)
therapy, at least in this country, according to Jeffrey Crawford, MD.
Although the Food and Drug Administration approved epoetin alfa (Epogen,
Procrit) based on evidence that it reduced the need for transfusions in
cancer patients with chemotherapy-related anemia, most current clinical use
of epoetin alfa is not to decrease transfusion needs. "I think we’re
convinced now that there is a quality-of-life benefit," Dr. Crawford
said (Figure 1), and epoetin alfa is now primarily directed at helping
cancer patients realize that benefit.
Dr. Crawford is professor of medicine in the divisions of oncology and
hematology at Duke University in Durham, North Carolina, and director of
clinical research at the Comprehensive Cancer Center at Duke University
Three community-based studiesthe Glaspy, Demetri, and Gabrilove trialshave
consistently demonstrated the relationship between improving hemoglobin
levels and overall quality of life in cancer patients receiving
chemotherapy. Although the trials were not randomized and had no control
arms, the large number of patientsmore than 7,000 totalmake the
database very robust, Dr. Crawford said. Together these studies represent
one of the largest prospective, open-label, nonrandomized databases of any
therapeutic agent in cancer research.
The studies all used linear analogue self-assessment (LASA) scores to
measure quality of life (Table 1) and the Demetri and Gabrilove trials also
included the Functional Assessment of Cancer Therapy-Anemia (FACT-An).
Across the trials, hemoglobin improved by 1.8 to 2.0 g/dL. The
improvement in levels was not only associated with a significant reduction
in the need for transfusions. The trials also "demonstrated the
profound relationship between hemoglobin level and quality of life,"
Dr. Crawford stated. Quality of life measurements improved in a stepwise
fashion and in direct relation to increases in hemoglobin levels, and were
particularly significant among patients who achieved an improvement of 2 g/dL
in hemoglobin levels.
Target Hemoglobin Level?