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Preventing Anemia Maintains QOL During Adjuvant Chemo

Preventing Anemia Maintains QOL During Adjuvant Chemo

SAN ANTONIO—Once-weekly treatment with recombinant human erythropoietin (epoetin
alfa, Epogen, Procrit), given concurrently with adjuvant chemotherapy for
breast cancer, maintains or improves hemoglobin levels while attenuating
decreases in quality of life (QOL), interim trial results show.

The findings suggest that epoetin can be protective against
chemotherapy-associated anemia and QOL decrements in these patients, Julie R.
Gralow, MD, said at the 25th Annual San Antonio Breast Cancer Symposium
(abstract 539).

With results available for 721 of approximately 1,800 patients, it appears
as if a prophylactic approach to anemia is warranted, said Dr. Gralow,
associate professor of medical oncology, University of Washington School of
Medicine, Seattle. "To be reimbursed for epoetin alfa, typically we have to
wait until the patient is already anemic and has a low energy level," she said.
"This is a proof of principle that we can prevent anemia from occurring in
these patients."

Previous investigations showed that epoetin improves hemoglobin levels and
QOL in breast cancer patients after they become anemic on chemotherapy or
chemoradiation. For example, a large, community-based trial of breast cancer
patients with anemia and impaired QOL on chemotherapy showed that epoetin
increased hemoglobin by a mean of approximately 2 g/dL, while QOL improved
significantly (P < .05) (Gabrilove et al: J Clin Oncol
19:2875-2882, 2001).

The next step was to consider giving hematologic support before anemia
arises. Dr. Gralow and her colleagues undertook an open-label, nonrandomized,
multicenter, community-based study to evaluate once-weekly epoetin in women
with stage I-III breast cancer receiving standard adjuvant chemotherapy (an-thracycline
with or without a taxane) for 3 to 6 months. They performed hematologic and
quality-of-life assessments, then compared the results with historical controls
taken from an earlier study of women with early-stage breast cancer who
received adjuvant chemotherapy and no hematologic support (Lawless et al:
96:390b [abstract 5447], 2000).

For 721 evaluable patients (mean age, 53.5 years), mean hemoglobin level at
baseline was 12.3 g/dL (comparable to 12.1 g/dL in the historical controls).
Subcutaneous epoetin was given at 40,000 U/wk for up to 24 weeks, with dose
adjustments up to 60,000 U if needed.

The mean final hemoglobin level among the women in the current study was
13.2 g/dL, or a mean increase of 0.9 g/dL from baseline (P < .05). Among
the historical controls, there was a mean decrease in hemoglobin levels of 2.0
g/dL after four treatment cycles of adjuvant chemotherapy without epoetin.


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