Background: Anemia is a common problem in the cancer population that is the result of clinical consequences. It also has adverse effects on patients’ perceived quality of life. Good management of anemia in the cancer population is therefore essential. A recent published clinical trial has demonstrated statistically significant increases in hemoglobin levels and significantly increased QOL assessment following the administration of recombinant erythropoietin.
Objective: To evaluate the effectiveness, the safety, and the quality of life by using once weekly dosing of Epoetin alfa (Eprex,Janssen-cilag) 40,000 units in the treatment of anemia in cancer patients receiving chemotherapy.
Setting: Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand
Material and Method: This was an open label, non randomized study, in 41 adult male and female anemic cancer patients who had non-myeloid malignancies in the upper area of the body part and hemoglobin ranging from 9-11 g/dL receiving chemotherapy at least 8 weeks with or without concurrent radiotherapy. The subjects were treated with Epoetin alfa 40,000 units once a week subcutaneously. If, the hemoglobin did not increase by > 1.0 g/dl after 4 weeks of treatment, the dose of Epoetin alfa was then increased to 60,000 units per dose subcutaneously at week 5. The Epoetin alfa treatment would continue for a total of 16 weeks. Clinical outcome was evaluated based on quality of life by using the linear analog scale assessment (LASA) and the functional assessment of cancer therapy-anemia (CU-QOL) instrument. Analyses were performed to determine the incremental change in QOL associated with hemoglobin increases.
Results: Seventy six percent of patients receiving Epoetin alfa subcutaneously showed good response with hemoglobin increases of > 1g/dL (Hb level before and after = 9.82 + 0.78 g/dL and 12.56 + 1.49 g/dL, respectively; p < 0.001). Improvement of all primary cancer- and anemia-specific QOL domains, including energy level and ability to do daily activities evaluated from LASA and fatigue assessed from CU-QOL, were significantly greater (p < 0.01) for week 16 (233.94 + 56.01 and 18.45 + 13.07) compared to the baseline (202.58 + 36.74 and 25.09 + 11.00). Epoetin alfa was well tolerated in all patients.
Conclusion: Once weekly dosing of Epoetin alfa 40,000 units therapy is safe and effective in remodeling anemia and significantly improves the quality of life in cancer patients receiving chemotherapy. Therefore, the physician should maintain hemoglobin concentration of cancer patients in normal level to improve their quality of life through the chemotherapy period.

Keywords: Non-myeloid malignancy, Epoetin alfa, Anemia, Quality of life