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Epoetin Alfa 60,000 U Once Weekly Followed by 120,000 U Every 3 Weeks Increases and Maintains Hemoglobin Levels in Anemic Cancer Patients Undergoing Chemotherapy

^a Tennessee Oncology, Nashville, Tennessee, USA; ^b Ortho Biotech Products, L.P., Bridgewater, New Jersey, USA

Correspondence: Jeffrey Patton, M.D., Tennessee Oncology Southern Hills, 397 Wallace Road, Suite 201, Nashville, Tennessee 37211-8025, USA. Telephone: 615-333-2481; Fax: 615-781-3923; e-mail: jpatton{at}tnonc.com

Purpose. Epoetin alfa administered s.c. three times weekly or once weekly increases hemoglobin (Hb) levels, decreases transfusion requirements, and improves quality of life in anemic cancer patients receiving chemotherapy. This study assessed the feasibility of using higher initial doses of once-weekly epoetin alfa followed by less frequent maintenance doses to increase and then maintain adequate Hb levels in this population.

Materials and Methods. In this open-label, nonrandomized, pilot study, anemic (baseline Hb 11 g/dl) cancer patients undergoing chemotherapy received initial doses of epoetin alfa of 60,000 U s.c. once weekly to increase Hb levels by at least 2 g/dl, followed by 120,000 U s.c. every 3 weeks to maintain Hb levels. The maximum treatment duration was 24 weeks.

Results. The mean baseline Hb level was 10.1 ± 0.8 g/dl (n = 20). Once-weekly dosing resulted in mean Hb level increases of 1.0 ± 1.1 g/dl by week 4 and 2.9 ± 1.9 g/dl by week 8; 86% and 79% of patients evaluable at week 8 and week 12, respectively, demonstrated increases of at least 2 g/dl (target Hb level of 12 g/dl). Thirteen patients (65%) received at least one maintenance dose; the mean Hb level increased from 12.8 ± 1.1 g/dl before starting maintenance therapy to 13.3 ± 1.4 g/dl at the last maintenance week. Both dosage regimens were well tolerated.

Conclusions. Once-weekly epoetin alfa at a dose of 60,000 U effectively increased Hb levels by week 8; 86% of patients achieved rises of at least 2 g/dl or Hb levels 12 g/dl. Moreover, epoetin alfa at doses of 120,000 U every 3 weeks maintained or increased Hb levels. Results from this pilot study suggest that higher initial once-weekly dosing of epoetin alfa followed by less frequent maintenance dosing appears to be feasible for treating anemia in cancer patients undergoing chemotherapy. Further evaluation of these and other epoetin alfa dosage regimens is warranted.

Key Words. Epoetin alfa • Anemia • Antineoplastic agents • Neoplasms • Erythropoietin • Drug administration schedule

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