Weekly Epoetin Alfa Maintains Hemoglobin, Improves Quality of Life, and Reduces Transfusion in Breast Cancer Patients Receiving Chemotherapy

Chang, José; Couture, Félix; Young, Scott D.; McWatters, Kara-Lee; Lau, Catherine Y.

doi:10.1200/jco.2004.12.027

Cited by 159 publications

(102 citation statements)

References 16 publications

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“…Contrary to the higher early mortality seen in the BEST study, Chang et al [29] did not observe a shorter survival time in the ESA group of patients. In the Chang et al [29] study, the epoetin arm showed a similar 2-year survival rate and no difference in thromboses. The BRAVE study, in 463 metastatic breast cancer patients receiving chemotherapy (anthracycline and/or taxane based), compared once-weekly epoetin beta with control (transfusions allowed as clinically indicated in both arms) [24].…”

Section: Update Of Recent Breast and Cervical Cancer Clinical Studiesmentioning

confidence: 42%

“…A possible reason for the impaired survival seen with the ESA group in the BEST study in the first year of study (particularly in the first 4 months after randomization) may not have been a result of tumor progression, but possibly thromboembolic events. Chang et al [29] conducted a study in 354 breast cancer patients receiving chemotherapy, comparing once-weekly epoetin alfa with standard care. Contrary to the higher early mortality seen in the BEST study, Chang et al [29] did not observe a shorter survival time in the ESA group of patients.…”

Section: Update Of Recent Breast and Cervical Cancer Clinical Studiesmentioning

confidence: 99%

“…Chang et al [29] conducted a study in 354 breast cancer patients receiving chemotherapy, comparing once-weekly epoetin alfa with standard care. Contrary to the higher early mortality seen in the BEST study, Chang et al [29] did not observe a shorter survival time in the ESA group of patients. In the Chang et al [29] study, the epoetin arm showed a similar 2-year survival rate and no difference in thromboses.…”

Section: Update Of Recent Breast and Cervical Cancer Clinical Studiesmentioning

confidence: 99%

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Update on Erythropoiesis-Stimulating Agents and Clinical Trials in Oncology

Aapro

Spivak

2009

The Oncologist

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Anemia commonly occurs among cancer patients receiving chemotherapy. In these patients, erythropoiesisstimulating agents (ESAs) are effective in managing anemia but there is an increased risk for thrombovascular events. In more recent randomized clinical trials, there have been differing results regarding the impact of ESAs on overall survival and mortality. The balance between studies that show higher ESA-associated mortality and those that don't show ESA-associated mortality is examined in this review. This review discusses where we stand today on anemia management in cancer patients. Preliminary results from a recent independent patient data meta-analysis for on-study deaths and overall survival in patients receiving chemotherapy (the only oncology population for which ESA treatment is currently indicated) showed no statistically significant difference between the ESA and control groups (onstudy deaths hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.98 -1.24; overall survival HR, 1.04; 95% CI, 0.97-1.11, compared with controls). Possible factors that could influence study results are discussed in this review. There are no convincing data to support ESAinduced tumor stimulation in patients. ESAs decrease RBC transfusion needs and sustain targeted hemoglobin levels, and this ESA response does not significantly impact overall survival or mortality when ESAs are used within guidelines and labeling. However, based on the currently available data and meta-analysis, the use of ESAs has to be carefully balanced against any possible risk for higher mortality. The Oncologist 2009;14(suppl 1):6 -15

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Section: Update Of Recent Breast and Cervical Cancer Clinical Studiesmentioning

confidence: 42%

Section: Update Of Recent Breast and Cervical Cancer Clinical Studiesmentioning

confidence: 99%

Section: Update Of Recent Breast and Cervical Cancer Clinical Studiesmentioning

confidence: 99%

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Update on Erythropoiesis-Stimulating Agents and Clinical Trials in Oncology

Aapro

Spivak

2009

The Oncologist

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“…A meta-analysis of data from 15 randomized controlled trials of epoetin showed a consistently high rate of hematologic response, with an overall risk ratio of 3.42 (95% confidence interval [CI], 3.03-3.06) relative to control (Table 1) [13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The likelihood of Hb response is at least as large when the starting Hb level is 10-12 g/dl as it is when baseline Hb is <10 g/dl.…”

Section: Esasmentioning

confidence: 99%

Treatment Options for Anemia, Taking Risks into Consideration: Erythropoiesis-Stimulating Agents Versus Transfusions

Spano

Khayat

2008

The Oncologist

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“…Epoetin alfa therapy has been shown in both double-blind, placebo-controlled, and open-label studies to increase Hb levels in cancer patients receiving platinum-or nonplatinum-based chemotherapy, correcting anaemia, decreasing transfusion requirements, and subsequently improving patients' QOL (Abels, 1992;Leitgeb et al, 1994;Glaspy et al, 1997;Demetri et al, 1998;Dammacco et al, 2001;Gabrilove et al, 2001;Littlewood et al, 2001;Thomas, 2002;Janinis et al, 2003;Shasha et al, 2003;Savonije et al, 2004;Chang et al, 2005;Witzig et al, 2005). However, few studies to date have examined the outcome of anaemia treatment in ovarian cancer patients, and none have specifically evaluated the impact of anaemia treatment on QOL in this population (ten Bokkel Huinink et al, 1998).…”

mentioning

confidence: 99%

Epoetin alfa in platinum-treated ovarian cancer patients: results of a multinational, multicentre, randomised trial

Wilkinson

Antonopoulos²,

Lahousen

et al. 2006

Br J Cancer

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This multicentre, open-label, controlled clinical trial assessed the effects of epoetin alfa treatment on haematologic and quality of life (QOL) parameters in 182 anaemic (Hbp12 g dl À1 ) ovarian cancer patients receiving platinum chemotherapy. Patients were randomised 2 : 1 to receive epoetin alfa 10 000 -20 000 IU three times weekly plus best standard treatment (BST) or BST only. Main study end points were changes from baseline in haemoglobin (Hb) level, transfusion requirements, and QOL. For the epoetin alfa group, mean Hb increased by 1.8 g dl À1 by weeks 4 -6 and was significantly increased from baseline through study end (Po0.001). The mean change in Hb from baseline was significantly (Po0.001) greater for epoetin alfa than BST patients at all postbaseline evaluations. Significantly fewer epoetin alfa than BST patients required transfusion(s) after the first 4 weeks of treatment (7.9 vs 30.5%; Po0.001). Also, significant (Pp0.04) differences favouring the epoetin alfa group over the BST group were found for all three median CLAS scores (Energy Level, Ability to Do Daily Activities, Overall QOL) and the median average CLAS score during chemotherapy. These findings support use of epoetin alfa to increase Hb levels, reduce transfusion use, and improve QOL in anaemic ovarian cancer patients receiving platinum chemotherapy.

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Weekly Epoetin Alfa Maintains Hemoglobin, Improves Quality of Life, and Reduces Transfusion in Breast Cancer Patients Receiving Chemotherapy

Abstract: Epoetin alfa administered at 40,000 U qw is effective in improving QOL, maintaining hemoglobin level, and reducing transfusion requirements in breast cancer patients. The high effectiveness observed could be attributed in part to early treatment with epoetin alfa.

Cited by 159 publications

References 16 publications

Update on Erythropoiesis-Stimulating Agents and Clinical Trials in Oncology

Update on Erythropoiesis-Stimulating Agents and Clinical Trials in Oncology

Treatment Options for Anemia, Taking Risks into Consideration: Erythropoiesis-Stimulating Agents Versus Transfusions

Epoetin alfa in platinum-treated ovarian cancer patients: results of a multinational, multicentre, randomised trial

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