Protection of metabolic and exercise capacity in unselected weight-losing cancer patients following treatment with recombinant erythropoietin: A randomized prospective study

This study was aimed at evaluating whether anemia could be prevented in uns elected weight-losing cancer patients on anti-inflammatory treatment by ear ly and prophylactic treatment with recombinant human erythropoietin (rhEPO) and whether such a benefit could be translated into improved physical func tion and metabolic efficiency, One hundred eight cancer patients who experienced progressive cachexia due to solid, mainly gastrointestinal tumors were randomized to receive twice d aily a cyclo-oxygenase inhibitor (controls; indomethacin, 50 mg twice a day ) or indomethacin and erythropoietin, provided on individual basis to preve nt development of progressive anemia (study patients; indomethacin, 50 mg t wice a day plus rhEPO; range, 12,000-30,000 units per week), All patients w ere treated and followed up until death or to preterminal stage, Biochemica l tests (blood, liver, kidney, and thyroid), nutritional state assessment ( food intake and body composition), and exercise testing with simultaneous m easurements of respiratory gas: exchanges before and during exercise were p erformed before? institution of treatments and then at regular intervals du ring the treatment period (2-30 months after start), Study and control patients did not differ in survival. rhEPO prevented deve lopment of anemia during the entire observation period. This was associated with a significantly more preserved maximum exercise capacity in study pat ients compared to control patients during the follow-up period (101 +/- 10 versus 66 +/- 6 W; P < 0.0001), based on more effective ventilation and who le-body respiratory gas exchanges. These improvements were also evident whe n exercise performance was normalized to lean body mass, an indirect measur e of the skeletal muscle mass. The metabolic efficiency, expressed as oxyge n uptake per watt produced, was also significantly preserved in rhEPO-treat ed patients compared to controls (14.1 +/- 1.1 verses 16.3 +/- 0.9 mi O-2/W , P < 0.05). Our results demonstrate that institution of early and prophylactic rhEPO tr eatment to patients with progressive cancer prevents development of tumor-i nduced anemia, This achievement was associated with a better preserved exer cise capacity, which is explained in part by improved whole-body metabolic and energy efficiency during work load.