RECOMBINANT-HUMAN-ERYTHROPOIETIN FOR THE CORRECTION OF CANCER-ASSOCIATED ANEMIA WITH AND WITHOUT CONCOMITANT CYTOTOXIC CHEMOTHERAPY

Background. Chronic anemia is a common complication in patients with c ancer, especially in those with advanced disease or who are under inte nsive chemotherapy. Because homologous blood transfusions involve some hazards, the safety and efficacy of recombinant human erythropoietin (r-HuEPO) in the treatment of anemic patients with cancer with and wit hout concomitant chemotherapy were studied. Methods. One-hundred two c ancer patients with hemoglobin less than 11 g/dl, ferritin greater tha n 30 mu g/l, and creatinine < 220 mu mol/l were enrolled in the study, 94 were eligible for efficacy evaluation, Sixty-eight patients receiv ed chemotherapy (CT group) and 26 had no cytotoxic cancer treatment (N T group). Recombinant human erythropoietin was administered subcutaneo usly at a dose of 150 U/kg three times per week for 6 weeks; in nonres ponders the dose was doubled for the subsequent 6 weeks. Response was defined as the achievement of a hemoglobin increase of 2 g/dl. Clinica l and laboratory parameters, including serum erythropoietin (EPO) leve ls, performance status, and quality of life, were investigated at base line and monitored at regular intervals thereafter. Results. Response was achieved by 52% and 62% of CT and NT patients, respectively, The h ighest response rates were observed in patients with lung cancer or wi th a histology of squamous cell. carcinoma (both 80%), In responding p atients, the symptoms of anemia subsided. They no longer needed blood transfusions after 4 weeks of therapy; and both their performance stat us and quality of life improved significantly, The NT patients achieve d slightly more favorable results on lower weekly doses: 450 U/kg/week in NT versus 570 U/kg/week in CT patients. Serum EPO levels were high er in nonresponders at baseline and further increased during the cours e of treatment. Recombinant human erythropoietin was well tolerated by all patients. Conclusion. This multicenter study in a large patient c ollective shows that r-HuEPO treatment represents a safe and effective means to increase the red cell mass and eliminate the need for blood transfusions in approximately 50% of the patients with chronic anemia of cancer. Responding patients not only have increased levels of hemog lobin, but their performance status also improves significantly, and t hey enjoy a significantly enhanced quality of life.