Treatment of chemotherapy-induced anemia with recombinant human erythropoietin in cancer patients.

Platanias, Leonidas C.; Miller, Carole B.; Mick, Rosemarie; Hart, Ronald D.; Ozer, Howard; McEvilly, Jan Marie; Jones, Richard J.; Ratain, Mark J.

doi:10.1200/jco.1991.9.11.2021

Cited by 107 publications

(38 citation statements)

References 13 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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Recombinant Human Erythropoietin Treatment for Chemotherapy-related Anemia in Children

et al. 1999

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ABSTRACT. Objective. The efficacy and safety of recombinant human erythropoietin (rHuEPO) treatment in chemotherapy-induced anemia in children were investigated. rHuEPO is used to treat chemotherapy-induced anemia. Several studies recommend 150 to 300 IU/kg rHuEPO for 2 to 8 months. There are only a few controlled trials in children and no precise data about the optimal dose and duration of rHuEPO treatment is available.Patients and Methods. Thirty-four patients receiving chemotherapy for treatment of their solid tumors between October 1996 and June 1997 were included in this study. Patients were randomly selected for each group. The male/female ratio was 20/14, and the median age was 5 years (range, 1-16 years). They had normal hemoglobin levels at the time of diagnosis. When hemoglobin levels decreased to levels lower than 10 g/dL, rHuEPO (150 IU/kg/d, 3 times a week, subcutaneously) was given to 17 patients for 2 months. Their renal, liver, and pulmonary functions were normal. None of the patients had hematologic disease. We did not use any other drugs such as iron or granulocyte colony-stimulating factor. There were 17 patients in the control group. Fifteen patients got chemotherapy regimens including cisplatin (CDDP), but 19 were treated with regimens without CDDP. At the end of rHuEPO treatment, all patients were examined in terms of transfusion requirements and rate of change in hemoglobin levels.Results. One patient in the study group needed a blood transfusion, whereas 8 patients needed a transfusion in the control group. Patients in the study group had less transfusion requirements compared with the control group. The mean hemoglobin levels before and after the study were 8.48 ؎ 0.98 g/dL and 8.41 ؎ 1.65 g/dL in the control group and 8.50 ؎ 0.85 g/dL and 10.21 ؎ 2.14 g/dL in the rHuEPO group, respectively. Optimal hemoglobin increments began in 4 weeks and continued during treatment. CDDP-receiving and CDDP-nonreceiving groups did not have any difference in pretreatment serum erythropoietin levels. rHuEPO treatment was more effective in patients treated with non-CDDP regimens. Mean hemoglobin level increased from 8.68 ؎ 0.73 g/dL to 10.26 ؎ 1.84 g/dL in 9 patients treated with non-CDDP chemotherapy regimens in the erythropoietin group, although it increased from 8.28 ؎ 0.97 g/dL to 10.15 ؎ 2.5 g/dL in 8 patients treated with CDDP-containing regimens in the erythropoietin group. rHuEPO caused high blood pressure in only 1 patient that resolved spontaneously after cessation of erythropoietin treatment for a week.Conclusion. rHuEPO treatment (150 IU/kg/d 3 times a week) is effective and safe in children with chemotherapy-induced anemia. It decreases blood transfusion requirements in solid tumor patients. Our results show that the response to rHuEPO in CDDP-induced anemia is less than the response in non-CDDP receiving patients. Higher doses may be necessary in patients using CDDP. Pediatrics 1999;103(2). URL: http://www.pediatrics.org/ cgi/content/full/103/2/e16; erythropoietin, solid tumors, chemotherapy...

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Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

Recombinant Human Erythropoietin Treatment for Chemotherapy-related Anemia in Children

et al. 1999

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“…Recombinant erythropoietin (r-HuEPO) has previously been shown to increase the haematocrit and reduce the transfusion requirement in patients with end-stage renal disease undergoing haemodialysis (Esbach et al, 1989) and in AIDS patients treated with zidovudine (Fischl et al, 1990). In addition, there are now a number of reports on the use of r-HuEPO to correct anaemia in cancer patients (Platanias et al, 1991;Abels, 1992aAbels, ,b, 1993Miller et al, 1992;Case et al, 1993;Lavey and Dempsey, 1993;Ludwig et al, 1993Ludwig et al, , 1994Vijayakumar et al, 1993;Dusenbery et al, 1994;Leitgeh et al, 1994;deCampos et al, 1995). In the largest randomized trial published to date, Abels (1993) demonstrated that r-HuEPO corrected anaemia and reduced transfusion requirements compared with a control group for patients with a variety of cancers undergoing chemotherapy.…”

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Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

Sweeney

Nicolae²,

Ignacio³

et al. 1998

Br J Cancer

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Summary The purpose of this study was to determine the safety, efficacy and impact on quality of life of recombinant human erythropoietin (r-HuEPO) for cancer patients undergoing radiotherapy (RT). An open-labelled randomized design was used, with patients randomized to either treatment or control arms. Patients in the treatment arm received r-HuEPO given by subcutaneous injection at a dose of 200 units kg-' day-' plus oral iron supplements (ferrous sulphate 325 mg p.o. t.i.d.). Entry was restricted to patients with carcinoma of the lung, uterine cervix, prostate or breast who presented for RT with anaemia parameters reflective of 'the anaemia of chronic disease'. Radiotherapy policies (portals, doses, fraction size, etc.) were determined by the site and stage of disease. Complete blood counts (CBCs) were obtained weekly. The target level of haemoglobin was 15 g dl-1 for men and 14 g dl-1 for women. Quality of life (QOL) was assessed weekly by using an analogue scale to judge energy, activities of daily living and overall quality of life. Forty-eight patients were entered in the study, 24 in the treatment arm and 24 in the control arm. The prerandomization demographic characteristics and mean laboratory values were comparable in both arms. The mean haemoglobin at completion was 13.6 g dl-1 for r-HuEPO-treated patients compared with 11.0 g dl-1 for control subjects (P= 0.0012). Patients who received r-HuEPO demonstrated a mean weekly haemoglobin increase of 0.41 g dl-1 compared with a decrease in mean haemoglobin level in controls for 6 of the 7 weeks of the study (mean weekly decrease of 0.073 g dl-'). Target levels of haemoglobin were achieved by 41.6% of r-HuEPO-treated patients compared with none of the control subjects. The mean platelet count declined in both arms of the study with RT but the decline from pretreatment was less rapid in r-HuEPO-treated patients (11.2% decrease) compared with controls (26.3% decrease) and was statistically significant during weeks 4-6. Toxicity was minor with only mild irritation at the injection site. Mean quality of life end points were superior in the treatment arm but not statistically significant. r-HuEPO had a beneficial effect on weekly haemoglobin levels in patients undergoing RT with response rates similar to other studies. There was also a less rapid decline in weekly platelet counts in r-HuEPO-treated patients compared with control subjects. Further studies are needed to address the optimum dose and scheduling as well as the impact of r-HuEPO on clinical outcomes.

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“…Administration of EPO has convincingly been shown to increase haematocrit and decrease transfusion requirement in 40-70% of patients with chronic anaemia of cancer [8,9]. It also prevents or ameliorates anaemia in patients undergoing chemotherapy with or without cisplatin [8,10] and improves haemoglobin levels in HIV infected patients experiencing anaemia while receiving zidovudine treatment [11]. EPO reduces red cell transfusion requirements in patients undergoing allogeneic bone marrow transplantation [12] but not in those subjected to transplantation of autologous bone marrow or peripheral blood stem cells.…”

Section: Clinical Application Of Erythropoietin In Chronic Anaemia Ofmentioning

confidence: 99%

A European perspective on haematopoietic growth factors in haemato-oncology: Report of an expert meeting of the EORTC

Croockewit

Bronchud

Aapro

et al. 1997

European Journal of Cancer

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Treatment of chemotherapy-induced anemia with recombinant human erythropoietin in cancer patients.

Cited by 107 publications

References 13 publications

Recombinant Human Erythropoietin Treatment for Chemotherapy-related Anemia in Children

Recombinant Human Erythropoietin Treatment for Chemotherapy-related Anemia in Children

Effect of subcutaneous recombinant human erythropoetin in cancer patients receiving radiotherapy: final report of a randomized, open-labelled, phase II trial

A European perspective on haematopoietic growth factors in haemato-oncology: Report of an expert meeting of the EORTC

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