Dose reduction of epoetin-alpha in the prevention of chemotherapy-induced anaemia

Lüthi, François ; Pless, Miklos ; Leyvraz, Serge ; Biedermann, Beat ; Müller, Emilie ; Hermann, Richard ; Monnerat, Christian

In: Supportive Care in Cancer, 2010, vol. 18, no. 12, p. 1515-1520

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    Summary
    Introduction: Anaemia during chemotherapy is often left untreated. Erythropoiesis-stimulating agents are frequently used to treat overt anaemia. Their prophylactic use, however, remains controversial and raises concerns about cost-effectiveness. Therefore, we assessed the efficacy of a dose-reduction schedule in anaemia prophylaxis. Materials and methods: The study included patients with untreated solid tumours about to receive platinum-based chemotherapy and had haemoglobin (Hb) levels ≥11g/dL. Epoetin-α was administered at a dose level of 3 × 10,000U weekly as soon as Hb descended to < 13g/dL. Dose reductions to 3 × 4,000U and 3 × 2,000U weekly were planned in 4-week intervals if Hb stabilised in the range of 11-13g/dL. Upon ascending to ≥13g/dL, epoetin was discontinued. Iron supplements of 100mg intravenous doses were given weekly. Of 37 patients who enrolled, 33 could be evaluated. Results and discussion: Their median Hb level was 13.7 (10.9-16.2) g/dL at baseline and descended to 11.0 (7.4-13.8) g/dL by the end of chemotherapy. Anaemia (Hb < 10g/dL) was prevented in 24 patients (73%). The mean dose requirement for epoetin-α was 3 × 5,866U per week per patient, representing a dose reduction of 41%. Treatment failed in nine patients (27%), in part due to epoetin-α resistance in four (12%) and blood transfusion in three (9%) patients. Conclusion: Dose reduction was as effective as fixed doses in anaemia prophylaxis but reduced the amount of prescribed epoetin substantially