Anemia is a common complication of cancer and can significantly impair a patient's quality of life, causing tiredness, shortness of breath, dizziness and other problems. Epoetin alfa stimulates bone marrow production of blood cells, thereby reducing anemia. "We are constantly looking for ways to make treatments easier for patients," says David Steensma, M.D., Mayo Clinic oncologist and lead author of the study. "Sometimes this means finding ways to treat side effects. In this case we studied how to treat a side effect without sacrificing as much of the patient's time and money."
Dr. Steensma and his team studied 360 patients who were randomly assigned to receive either the standard protocol of 40,000 units (40K) of epoetin alfa once a week for 21 weeks, or 40K units of epoetin alfa once a week for three weeks followed by 120,000 units (120K) of epoetin alfa once every three weeks for the remaining 18 weeks. The investigators found no statistical difference in the proportion of patients requiring transfusions due to low hemoglobin between the groups. Side effects, including thromboembolism (blood clot in a blood vessel) and overall survival also were similar. Hemoglobin levels were slightly greater throughout the study for the patients enrolled in the 40K group, but those receiving 120K every three weeks still maintained a level that did not require transfusions. At the end of the study, patients in each group reported a similar quality of life.
While they find the results of this study promising, Dr. Steensma and his team say that a larger study must be done to more definitively show equivalence between the two therapies. Although this reduced frequency dosing schedule would be more convenient for patients, the researchers say that clinicians will have to decide whether the potentially lower hemoglobin levels are an acceptable trade-off.
Other Mayo Clinic researchers involved with this study include: Jeff Sloan, Ph.D.; Paul Novotny; Steven Alberts, M.D.; and Charles Loprinzi, M.D. Additional NCCTG investigators include: Roy Molina, M.D., Iowa Oncology Research Association Community Clinical Oncology Program (CCOP), Des Moines, Iowa; Daniel Nikcevich, M.D., Duluth CCOP, Duluth, Minn.; Paul Schaefer, M.D., Toledo Community Hospital Oncology Program CCOP, Toledo, Ohio; Kendrith Rowland Jr., M.D., Carle Cancer Center CCOP, Urbana, Ill.; Todor Dentchev, M.D., Altru Health System, Grand Forks, N.D.; Loren Tschetter, M.D., Sioux Community Cancer Consortium, Sioux Falls, S.D.; Thomas Hogan, M.D., Scottsdale CCOP, Scottsdale, Ariz.; and Amy Law, M.D., Geisinger Clinic & Medical Center CCOP, Danville, PA.
NCCTG is a national clinical research group sponsored by the National Cancer Institute, comprised of a network of more than 1,000 community-based cancer treatment clinics in the United States, Canada and Mexico that work with Mayo Clinic to conduct clinical studies for advancing cancer treatment.
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