Epoetin Alfa in Cancer Patients

Abstract

Anemia is a common cause of cancer-related fatigue. A systematic review of the literature was performed to establish guidelines on the use of epoetin alfa for the treatment of anemia. The evidence in support of these guidelines was selected, reviewed, and summarized by the members of the Canadian Cancer and Anemia Guidelines Development Group. The effects of epoetin alfa on quality of life (QOL) in patients with cancer were examined in 5 randomized, placebo-controlled trials and 2 large, open-label, nonrandomized, community-based studies. The effects of epoetin alfa on red blood cell transfusion requirements were examined in 19 randomized controlled trials (RCTs) with 21 comparisons. All trials compared epoetin alfa to a suitable control group, examined specified outcome measures that could be analyzed, and studied patients with cancer who were receiving chemotherapy. Trials involving patients with hematologic malignancies originating in the bone marrow were excluded. Outcome measures included 1) quality of life (QOL) (as measured by scales including the Linear Analogue Self-Assessment [LASA] and the Functional Assessment of Cancer Therapy [FACT] subscales), and 2) transfusion requirements (as measured by the proportion of patients requiring transfusion and amount of transfusion). The analysis confirmed that epoetin alfa produced statistically significant and clinically relevant improvements in QOL in patients with cancer. The overall relative risk ratio for transfusion among patients receiving epoetin alfa was calculated to be 0.60 (95% Cl, 0.53-0.69; P < 0.00001), representing a 40% reduction in the proportion of patients requiring transfusion. These results support recommendations for the use of epoetin alfa in patients with cancer-related anemia.

Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer

“…In a recent systematic review originally prepared for the Cochrane Library, Bohlius and colleagues showed that while the administration of erythropoietin is clearly associated with significant increases in hemoglobin, the evidence that it also reduces fatigue is inconclusive [10]. This is in keeping with our clinical observations that the correction of the anemia with administration of erythropoietin according to evidence practice guidelines [70] or of Packed Red Cells rarely ameliorates fatigue to the degree intended. This finding suggests that other stressors experienced by individuals with advanced cancer also contribute to fatigue.…”

Pathophysiology of Cancer-Related Fatigue

“…11 Available evidence supports the correlation between anemia and fatigue. 25,26 Chemotherapy drugs that cross the blood-brain barrier may induce neurotoxicities that produce fatigue. 24 Most patients experience fluctuations in fatigue during high-dose chemotherapy paired with stem cell transplantation, with fatigue increasing as the patients’ blood counts approach white blood cell nadir but improving as counts recover.…”

Chemotherapy and Cancer Related Fatigue: A Prospective Study in Rural Cancer Survivors of Malwa Region of Punjab

“…Studies have focused on understanding the factors that contribute to CRF, the treatment received, and a variety of chronic physical or psychological comorbid conditions (Wang, 2008). Some studies have stated that anemia and accumulation of end products from cell destruction causes fatigue (Turner et al, 2001;Demetri et al, 1998). It was seen that chemotherapy drugs that cross the blood-brain barrier might induce neurotoxicities which can produce fatigue (Smets et al, 1993).…”