Antianemic Effect of Once Weekly Regimen of Epoetin Alfa 40,000 Units in Anemic Cancer Patients Receiving Chemotherapy
Narin Voravud MD*, Virote Sriuranpong MD*, Harit Suwanrusme MD*
Affiliation : * Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University
Background : Anemia is a common problem in the cancer population that is the result of clinical conse-
quences. 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 admin-
istration of recombinant erythropoietin.
Objective : To evaluate the effectiveness, the safety, and the quality of life by using once weekly dosing of
Epoetin alfa (Eprex(cid:31),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 Univer-
sity Bangkok, Thailand
Materials and Methods : 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
