Erythropoietin reduces anemia and transfusions after chemotherapy with paclitaxel and carboplatin

Abstract

BACKGROUND The authors report on anemia observed during preoperative paclitaxel and carboplatin chemotherapy in patients with advanced head and neck carcinoma and discuss how the use of recombinant human erythropoietin (r‐HuEPO) ameliorates this anemia, reducing the need for subsequent packed red blood cell (PRBC) transfusions. METHODS Response to r‐HuEPO was defined as reduced hemoglobin fall during preoperative chemotherapy and reduced transfusion requirements during surgery. Thirty‐six patients with advanced head and neck carcinoma were evaluable after treatment with preoperative chemotherapy using paclitaxel and carboplatin. Group 1 was comprised of 14 patients who empirically received r‐HuEPO at a dose of 150 U/kg 3 times per week for 3 weeks; in patients deemed nonresponders, the dose was increased to 300 U/kg and 450 U/kg in the subsequent courses. Group 2 was comprised of 22 patients who did not receive r‐HuEPO. RESULTS During preoperative chemotherapy, the mean hemoglobin fall was 0.5 g/dL in Group 1 (P = 0.40). In Group 2 there was a statistically significant mean hemoglobin fall of 3.3 g/dL (P < 0.0001). There was also a nonstatistically significant trend toward fewer PRBC transfusions: none of 14 patients (0%) in Group 1 versus 4 of 22 patients (18%) in Group 2 (P = 0.141). CONCLUSIONS A significant fall in hemoglobin and an increase in the need for transfusions were observed in head and neck carcinoma patients receiving carboplatin and paclitaxel chemotherapy prior to surgery. Empiric r‐HuEPO therapy appeared to prevent anemia and reduced the need for PRBC transfusions. Cancer 1997; 79:1623‐8. © 1997 American Cancer Society.

Recombinant Human Erythropoietin Treatment for Chemotherapy-related Anemia in Children

“…3,4 Several studies showed efficacy of rHuEPO in these patients. 2,5,6 Serum erythropoietin levels were found to be normal, low, or high in these studies. Different studies recommend 150 to 300 IU/kg rHuEPO for 4 to 8 months.…”

“…Most of rHuEPO studies are related with adult cases. 2,[5][6][7]11,12 Firstly, Miller and coworkers 5 mentioned that adult patients who had received high rHuEPO doses (100 -200 IU/ kg) showed a good response. Dunphy et al 6 reported that the rHuEPO dose should be increased in patients who used paclitaxel and carboplatin if the response was inadequate with 150 IU/kg.…”

“…Different studies recommend 150 to 300 IU/kg rHuEPO for 4 to 8 months. [5][6][7] There are only a few controlled trials in children and no precise data about the optimal dose and duration of rHuEPO treatment is available. 8 -10 The aim of our study is to investigate the efficacy and safety of rHuEPO in chemotherapy-induced anemia in children.…”

Prognostic Value of Hemoglobin Concentrations in Patients with Advanced Head and Neck Cancer Treated with Combined Radio-Chemotherapy and Surgery

“…Experimental [21] and clinical data [10,16,22] show that the application of erythropoietin is safe and well-tolerated. In recent reports it could be shown that correction of anemia by erythropoietin in patients with carcinomas of the head and neck reduced the need for blood transfusions [10] and increased the efficacy of a neoadjuvant radio-chemotherapy significantly [16].…”

Recombinant human erythropoietin in the treatment of anemic patients with hematological malignancies

“…There are several randomized studies demonstrating the effect of erythropoietin in preventing anemia in patients with solid tumors [26,30,58,63,80,103]. …”