NASHVILLEInterim results from a small pilot study suggest oncologists
might be able to give epoetin alfa (Procrit) in a high-dose regimen that
lengthens the time between injections once anemic patients reach maintenance
levels of hemoglobin (ASCO abstract 1469).
The experimental regimen begins with weekly injections of 60,000 units,
and can switch to 120,000 units administered every 3 weeks after a patient’s
hemoglobin level rises 2 g/dL or more above baseline. Lead investigator
Jeffrey Patton, MD, of Tennesee Oncology in Nashville reported that 11 of 20
chemotherapy patients in the trial have reached the threshold for entering
the maintenance phase and so far are sustaining their hemoglobin levels with
the less frequent injections.
Epoetin alfa is usually given in weekly 40,000 units that can go up to
60,000 units if hemoglobin levels do not respond. It is approved for use in
anemic cancer patients receiving chemotherapy for nonmyeloid malignancies.
Threshold for Raising Dose
Previous investigations have established that weekly doses of epoetin
alfa produce benefits similar to doses given three times a week. Dr. Patton
said front-loading epoetin alfa with a high initial dose has been looked at
but not in large numbers of cancer patients. "To my knowledge this has
not been done in a chemotherapy-induced setting," he said.
All 20 patients in the nonrandomized pilot study had hemoglobin levels of
11 g/dL or less, and were receiving chemotherapy for a nonmyeloid
malignancy. Patients who had been treated with epoetin alfa or any
investigational form of erythropoietin were excluded.
Everyone started on the 60,000-unit dose. Although this is 50% higher
than the standard dose of epoetin alfa, Dr. Patton said that it is not
uncommon, as about one-quarter of patients receiving the standard dose end
up being raised to 60,000 units. The study protocol allows patients to move
to the 120,000-unit maintenance schedule after 8 weeks, providing their
hemoglobin counts have met the threshold for improvement. Seven of the 11
patients on maintenance therapy reached the threshold at 9 weeks.