Managing anemia with epoetin alfa in patients with rectal cancer

Abstract

Background. Anemia is one of the most challenging problems in clinical CLINICAL ONCOLOGY due to its high prevalence among the patients with malignant diseases. The purposes of our study were: (1) to assess the potential of epoetin alfa therapy to prevent the decline in Hb concentrations that typically accompanies chemotherapy/ radiotherapy (ChT/RT) of the patients with rectal cancer; (2) to test the hypothesis that the use of epoetin alfa significantly reduces the transfusion requirements in the patients with rectal cancer treated with ChT/RT after surgery, and (3) to evaluate the safety profile of the administration of epoetin alfa in the clinical setting.

Methods. Sixty patients who underwent surgery for rectal cancer were prospectively enrolled. Group A consisted of 39 patients with Hb concentrations ≤13 g/dl at the start of ChT/RT following surgery, and group B of 17 patients with Hb concentrations >13 g/dl at the start of ChT/RT following surgery, but whose Hb concentrations fell below 13 g/dl during the ChT/RT protocol. The starting dose of epoetin alfa in both groups was 10,000 IU subcutaneously (sc) three times a week (tiw). The following major parameters were evaluated: (1) change in Hb concentrations relative to the baseline as measured at 4-week intervals, (2) allogenic blood transfusion requirements in relation to Hb concentrations, and (3) incidence and severity of adverse events and their potential relationship to epoetin alfa administration.

Results. The study protocol was completed in 56/60 patients. In group A, a statistically significant increase in Hb concentration (p<0.001) was observed after the first 4 weeks of epoetin alfa treatment compared to the baseline values, with the mean increase of Hb concentration of 1.97 g/dl ± 0.91 g/dl and Hb concentrations remained significantly increased through the whole study (p=0.0017). In group B, a continuous decrease in Hb concentrations was observed during the first weeks of therapy, reaching the level of statistical significance after 3 weeks of postoperative treatment. After the initiation of epoetin alfa treatment, an increase of Hb concentrations and their maintenance at ≤12 g/dl was observed also in group B. Not a single patient enrolled in the study needed transfusion. None of described adverse events was connected to the epoetin alfa treatment.

Conclusions. The results of the present study show that epoetin alfa is safe and effective in maintaining Hb concentrations during the adjuvant therapy in rectal cancer patients. It significantly increases Hb concentrations and reduces transfusion requirements in the patients receiving chemoradiotherapy after surgery for rectal cancer.