Anaemia commonly occurs in cancer patients receiving chemotherapy, often necessitating blood transfusion. This multicentre study was designed to evaluate the efficacy and safety of epoetin α in preventing the decline in haemoglobin (Hb) level, and to determine whether the transfusion requirement could be reduced, in patients receiving 4–6 cycles of primarily platinum-based combination cyclic chemotherapy for small cell lung cancer (SCLC). A total of 130 non-anaemic SCLC patients were randomized to receive no additional treatment ( n = 44), epoetin α 150 IU kg −1 subcutaneously (s.c.) three times a week ( n = 42) or 300 IU kg −1 s.c. three times a week ( n = 44). Reductions in epoetin α dosage were made during the study if Hb level increased to >15 g dl −1 . The mean weekly dosage was 335 and 612 IU kg −1 , respectively, in the two active treatment groups. Significantly fewer ( P < 0.05) epoetin α-treated patients experienced anaemia (Hb < 10 g dl −1 ) during the course of chemotherapy (300 IU kg −1 , 39%; 150 IU kg −1 , 48%; untreated, 66%). This was reflected in the significantly lower number of treated patients transfused [300 IU kg −1 , 20% ( P < 0.001); 150 IU kg −1 , 45% ( P < 0.05); untreated, 59%]. Epoetin α was well-tolerated, and there was no evidence of sustained, clinically significant, hypertension. In summary, epoetin α is effective and well-tolerated in maintaining Hb level and reducing transfusion requirement in patients undergoing cyclic chemotherapy for SCLC. © 1999 Cancer Research Campaign

r-Hu-EPO at a dose of either 150 or 300 IU/kg three times weekly delays the onset of anemia and reduces RBC transfusion requirements in patients who undergo intensive chemotherapy for SCLC. A possible effect of r-Hu-EPO on platelet numbers deserves further study.

Background. Metastatic carcinoma of uncertain primary site (CUPS) is a common problem and has a poor prognosis. The intention of this study was to determine whether the addition of cisplatin and etoposide (PE) to vincristine, doxorubicin and cyclophosphamide (VAC) chemotherapy improves outcome. Methods. Fifty‐seven consecutive patients with an initial diagnosis of CUPS were studied. The first 40 patients had received six or 10 cycles of VAC and 17 patients VAC alternating with PE for six cycles. Review of histology using immunohistochemical techniques where appropriate was performed in all cases. Results. Histologic review resulted in six tumors reclassified as non‐Hodgkin's lymphoma (NHL), one as hepatocarcinoma, and one as adenocarcinoma. Six of the 11 responses occurred in patients with a review diagnosis of NHL. If the six cases of NHL and the case of hepatocarcinoma were excluded, there was no difference in survival between VAC and VAC/PE treated patients. Five patients with true CUPS who responded to VAC or VAC/PE had poorly differentiated histology, and this group (n = 24) also had a significantly longer survival. Conclusions. Some patients thought to have CUPS actually have NHL, and it is this group which responds well to chemotherapy. True CUPS patients respond to chemotherapy only if the tumor is poorly differentiated; survival is significantly longer for this group of patients. An advantage for VAC/PE over VAC chemotherapy was not identified.

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