Abstract
This randomised controlled multicentre trial evaluated the effectiveness of recombinant human erythropoietin (rhEPO) in preventing anaemia and reducing the need for blood or erythrocyte transfusion in 122 ovarian cancer patients receiving platinum-based chemotherapy. The patients were randomly allocated to receive rhEPO 150 U/kg or 300 U/kg subcutaneously, three times a week, or open control. Patients also received up to 6 cycles of carboplatin or cisplatin, alone or in combination with other cytotoxic agents. Intention-to-treat analysis showed that 39.4% of patients in the control group received at least one blood transfusion, compared with 9.2% of patients treated with rhEPO. Patients treated with rhEPO experienced a significantly longer time to first erythrocyte transfusion than the control group and were less likely to experience nadir haemoglobin levels <10 g/dl (P<0.001 and <0.05, respectively). A haemoglobin decrease <1 g/dl during the first chemotherapy cycle, as well as a low baseline serum erythropoietin concentration, predicted a low transfusion need in rhEPO-treated patients but not in controls. During the study, 103 patients suffered at least one adverse event, but no serious, and only nine non-serious adverse events were considered possibly related to rhEPO therapy. These results indicate that treatment with rhEPO prevents anaemia, it reduces the need for blood or rhEPO erythrocyte transfusion in patients with ovarian cancer receiving platinum-based chemotherapy, and it is well tolerated. A starting dose of 150 U/kg of rhEPO, three times a week, may be recommended.
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Abels R. Erythropoietin for anaemia in cancer patients.Eur J Cancer 1993;29A: 2–8.
Kaye SBet al. Randomized study of two doses of cisplatin with cyclophosphamide in epithelial ovarian cancer.Lancet 1992;340: 329–333.
Ludwig Het al. Erythropoietin treatment for chronic anemia of selected hematological malignancies and solid tumors.Ann Oncol 1993;4: 161–167.
Bush RS. The significance of anemia in clinical radiation therapy.Int J Radiat Oncol Biol Phys 1986;12: 2047–2050.
Girinski Tet al. Prognostic value of hemoglobin concentrations and blood transfusions in advanced carcinoma of the cervix treated by radiation therapy: results of a retrospective study of 386 patients.Int J Radiat Oncol Biol Phys 1989;16: 37–42.
Burrows L, Tartter P. Effect of blood transfusions on colonic malignancy recurrent rate [letter].Lancet 1982;ii: 662.
Foster RS Jr, Costanza MC, Foster JC, Wanner MC, Foster CB. Adverse relationship between blood transfusions and survival after colectomy for colon cancer.Cancer 1985;55: 1195–1201.
Balfour HH Jr. Transfusion and the human immunodeficiency virus.Transfusion 1993;33: 101–102.
Busch OR, Hop WC, Hoynck van Papendrecht MA, Marquet RL, Jeekel J. Blood transfusions and prognosis in colorectal cancer.N Engl J Med 1993;328: 1372–1376.
Heiss MMet al. Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologousversus allogeneic blood transfusion in colorectal cancer surgery.J Clin Oncol 1994;12: 1859–1867.
Wu HS, Little AG. Perioperative blood transfusions and cancer recurrence.J Clin Oncol 1988;6: 1348–1354.
Miller CBet al. A phase I/II trial of erythropoietin in the treatment of cisplatin-associated anemia.J Natl Cancer Inst 1992;84: 98–103.
Ludwig Het al. Erythropoietin treatment of anemia associated with multiple myeloma.N Engl J Med 1990;322: 1693–1699.
Cazzola Met al. Recombinant human erythropoietin in the anemia associated with multiple myeloma or non-Hodgkin’s lymphoma: dose finding and identification of predictors of response.Blood 1995;86: 4446–4453.
Platanias LCet al. Treatment of chemotherapy-induced anemia with recombinant human erythropoietin in cancer patients.J Clin Oncol 1991;9: 2021–2026.
de Campos Eet al. Clinical andin vitro effects of recombinant human erythropoietin in patients receiving intensive chemotherapy for small-cell lung cancer.J Clin Oncol 1995;13: 1623–1631.
Berdel WE, Oberberg D, Reufi B, Thiel E. Studies on the role of recombinant human erythropoietin in the growth regulation of human nonhematopoietic tumor cellsin vitro.Ann Hematol 1991;63: 5–8.
Neijt JP. Advanced ovarian cancer. Consultant series:The role of haematopoietic growth factors No. 4. Gardiner-Caldwell Communications: 1990.
Gershenson DMet al. Re-treatment of patients with recurrent epithelial ovarian cancer with cisplatin-based chemotherapy.Obstet Gynecol 1989;73: 798–802.
Markman Met al. The use of recombinant human erythropoietin to prevent carboplatin-induced anemia.Gynecol Oncol 1993;49: 172–176.
Beguin Y, Yerna M, Loo M, Weber M, Fillet G. Erythropoiesis in multiple myeloma: defective red cell production due to inappropriate erythropoietin production.Br J Haematol 1992;82: 648–653.
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ten Bokkel Huinink, W., de Swart, C., van Toorn, D. et al. Controlled multicentre study of the influence of subcutaneous recombinant human erythropoietin on anaemia and transfusion dependency in patients with ovarian carcinoma treated with platinum-based chemotherapy. Med Oncol 15, 174–182 (1998). https://doi.org/10.1007/BF02821936
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DOI: https://doi.org/10.1007/BF02821936