The effect of subcutaneous r-HuEPO in cancer patients receiving chemotherapy with anemia: A preliminary report

Background. Chemotherapy-related anemia in cancer patients is often encountered in clinical practice. It can reduce patient's compliance and tolerance to continuing chemotherapy. The mechanism of anemia may be ascribed to either decreasing serum EPO concentration or reducing sensitivity of EPO. Exogenous supply of EPO has shown to be effective in control of cancer- related anemia in early reports. This study preliminarily explored the efficacy and safety of r-HuEPO for cancer patients with anemia during the cytotoxic chemotherapy period in Taiwan. Methods. Sixteen cancer patients receiving cyclic chemotherapy with anemia (Hgb ≤ 10.5 g/dl) and without other systemic organ dysfunction, cerebral metastasis, uncontrolled hypertension, or presence of anemia attributable to causes other than cancer and chemotherapy entered the study. All patients received r-HuEPO 150 u/kg subcutaneous injection tiw for a total of 16 weeks. The efficacy determinations was based on the effect of r-HuEPO on hematological parameters, transfusion requirements, quality of life assessment, and physician's global assessment. Safety was assessed based on clinical laboratory tests, vital sign measurements and the incidence and severity of adverse experiences. Results. There were no changes of WBC and platelet count in 4, 8, 12 and 16 weeks of r-HuEPO therapy. The mean hemoglobin values at baseline, week 4, 8, 12, and 16 were 9.2±1.0 g/dl, 11.4±0.9 g/dl, 11.6±1.8 g/dl, 11.8±1.8 g/dl, and 12.2±2.3 g/dl, respectively (p < 0.001). The mean hematocrit values at baseline, week 4, 8, 12, and 16 were 28.3±3.4%, 36.0±2.8%, 36.3±5.7%, 37.8±6.0%, and 40.1±7.1%, respectively (p < 0.0005). The use of r-HuEPO had the marginal effect on the increase of patient's energy and activity. No adverse impacts on patient's vital signs were noted except 2 incidences of systolic hypertension and one episode of diastolic hypertension in the week 4. Conclusions. Subcutaneous injection of r-HuEPO at the dose of 150 u/kg tiw was safe and effective in increasing patient's hematocrit and RBC mass, and decreasing their blood transfusion requirement. Whether the current dosage of 150 u/kg tiw is the optimal treatment for chemotherapy-related anemia still needs further study.