Skip to main content

Advertisement

SpringerLink
Log in

Epoetin alfa increases hemoglobin levels and improves quality of life in anemic geriatric cancer patients receiving chemotherapy

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goal

To evaluate epoetin alfa (EPO) treatment of anemia in geriatric cancer patients receiving chemotherapy, a retrospective subgroup analysis was conducted of anemic cancer patients ≥65 years of age from three 16-week community-based studies of thrice-weekly (TIW) or once-weekly (QW) EPO for chemotherapy-related anemia (CRA).

Patients and methods

Analyses were conducted on the overall geriatric population (≥65 years) and by age subgroup (65–74, 75–84, and ≥85 years), and compared with younger patients (<65 years) for each individual study and for pooled data.

Main results

Some 3,634 geriatric patients were compared with 3,467 younger patients. From baseline to final measurement, EPO therapy significantly increased Hb by 2.0 g/dl in patients ≥65 years and 1.9 g/dl in patients <65 years (P<0.0001) and reduced transfusion utilization in both groups (P<0.006). Both age groups also had significant improvements in quality of life (QOL), measured by the 100-mm Linear Analog Assessment Scale (LASA). In younger patients, mean LASA changes were significantly greater than those in geriatric patients (P<0.05); however, QOL improvements in both age groups were clinically meaningful. There were no significant differences across geriatric age subgroups or between TIW and QW regimens for Hb change or QOL improvement. Overall hematopoietic response rate to EPO was 65.4% for patients ≥65 years and 64.7% for patients <65 years. Predictors of greater hematopoietic response (based on a pooled analysis) included lower body weight, baseline Hb, and baseline serum erythropoietin levels; better tumor response; and history of EPO dose reduction and longer time on study.

Conclusions

Anemic geriatric patients receiving EPO for CRA responded comparably to younger patients <65 years and should be treated similarly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Aapro MS, Cella D, Zagari M (2002) Age, anemia, and fatigue. Semin Oncol 29(Suppl 8):55–59

    Article  PubMed  Google Scholar 

  2. Baraldi-Junkins CA, Beck AC, Rothstein G (2000) Hematopoeisis and cytokines: relevance to cancer and aging. Hematol Oncol Clin North Am 14:45–61

    Article  PubMed  CAS  Google Scholar 

  3. Begg CB, Carbone PP (1983) Clinical trials and drug toxicity in the elderly: the experience of the Eastern Cooperative Oncology Group. Cancer 52:1986–1992

    Article  PubMed  CAS  Google Scholar 

  4. Beguin Y (1998) Prediction of response to optimize outcome of treatment with erythropoietin. Semin Oncol 25(Suppl 7):27–34

    PubMed  CAS  Google Scholar 

  5. Cascinu S, Del Ferro E, Fedeli A, Ligi M, Alessandroni P, Catalano G (1995) Recombinant human erythropoietin treatment in geriatric cancer patients with cisplatin-associated anemia. Oncology 52:422–426

    PubMed  CAS  Google Scholar 

  6. Cella D (1997) The Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 34(Suppl 2):13–19

    PubMed  CAS  Google Scholar 

  7. Cella D (1998) Factors influencing quality of life in cancer patients: anemia and fatigue. Semin Oncol 25(Suppl 7):43–46

    PubMed  CAS  Google Scholar 

  8. Christman K, Muss HB, Case LD, Stanley V (1992) Chemotherapy of metastatic breast cancer in the elderly: the Piedmont Oncology Association experience. JAMA 268:57–62

    Article  PubMed  CAS  Google Scholar 

  9. Curt GA, Breitbart W, Cella D et al (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5:353–360

    Article  PubMed  CAS  Google Scholar 

  10. Demetri GD, Kris M, Wade J, Degos L, Cella D, for the Procrit Study Group (1998) Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study. J Clin Oncol 16:3412–3425

    PubMed  CAS  Google Scholar 

  11. Gabrilove JL, Cleeland CS, Livingston RB, Sarokhan B, Winer E, Einhorn LH (2001) Clinical evaluation of once-weekly dosing of epoetin alfa in chemotherapy patients: improvements in hemoglobin and quality of life are similar to three-times-weekly dosing. J Clin Oncol 19:2875–2882

    PubMed  CAS  Google Scholar 

  12. Gelman RS, Taylor SG IV (1984) Cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy in women more than 65 years old with advanced breast cancer: the elimination of age trends in toxicity by using doses based on creatinine clearance. J Clin Oncol 2:1404–1413

    PubMed  CAS  Google Scholar 

  13. Giovanazzi-Bannon S, Rademaker A, Lai G, Benson AB 3rd (1994) Treatment tolerance of elderly cancer patients entered onto phase II clinical trials: an Illinois Cancer Center study. J Clin Oncol 12:2447–2452

    PubMed  CAS  Google Scholar 

  14. Glaspy J, Bukowski R, Steinberg D, Taylor C, Tchekmedyian S, Vadhan-Raj S, for the Procrit Study Group (1997) Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. J Clin Oncol 15:1218–1234

    PubMed  CAS  Google Scholar 

  15. Gough IR, Furnival CM, Schilder L, Grove W (1983) Assessment of the quality of life of patients with advanced cancer. Eur J Cancer Clin Oncol 19:1161–1165

    Article  PubMed  CAS  Google Scholar 

  16. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341:2061–2067

    Article  PubMed  CAS  Google Scholar 

  17. Kennedy BJ (2000) Aging and cancer. Oncology 14:1731–1733

    PubMed  CAS  Google Scholar 

  18. Lichtman SM, Skirvin JA (2000) Pharmacology of antineoplastic agents in older cancer patients. Oncology 14:1743–1755

    PubMed  CAS  Google Scholar 

  19. Littlewood TJ, Bajetta E, Nortier JWR, Vercammen E, Rapoport B, for the Epoetin Alfa Study Group (2001) Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 19:2865–2874

    PubMed  CAS  Google Scholar 

  20. McCormack HM, de L Horne DJ, Sheather S (1988) Clinical applications of visual analog scales: a critical review. Psychol Med 18:1007–1019

    Article  PubMed  CAS  Google Scholar 

  21. Naeim A, Reuben D (2001) Geriatric syndromes and assessment in older cancer patients. Oncology 15:1567–1580

    PubMed  CAS  Google Scholar 

  22. National Comprehensive Cancer Network (2006) Cancer- and treatment-related anemia: clinical practice guidelines in oncology, Version 2.2006

  23. Patrick DL, Gagnon DD, Zagari MJ, Mathijs R, Sweetenham J, for the Epoetin Alfa Study Group (2003) Assessing the clinical significance of health-related quality of life (HrQOL) improvements in anaemic cancer patients receiving epoetin alfa. Eur J Cancer 39:335–345

    Article  PubMed  CAS  Google Scholar 

  24. PROCRIT (epoetin alfa) (prescribing information) (2005) Ortho Biotech Products, L.P., Raritan, New Jersey

  25. Quirt I, Robeson C, Lau CY et al, and the Canadian Eprex Oncology Study Group (2001) Epoetin alfa therapy increases hemoglobin levels and improves quality of life in patients with cancer-related anemia who are not receiving chemotherapy and patients with anemia who are receiving chemotherapy. J Clin Oncol 19:4126–4134

    PubMed  CAS  Google Scholar 

  26. Shasha D, George M (2002) Rapid hemoglobin response in anemic cancer patients undergoing chemotherapy or chemoradiation therapy receiving once-weekly epoetin alfa treatment (abstract). Blood 11(pt 2):17b

    Google Scholar 

  27. Shasha D, George MJ, Harrison LB (2003) Once-weekly dosing of epoetin alfa increases hemoglobin and improves quality of life in anemic cancer patients receiving radiation therapy either concomitantly or sequentially with chemotherapy [abstract]. Cancer 98:1072–1079

    Article  PubMed  CAS  Google Scholar 

  28. Witzig TE, Silberstein PT, Loprinzi CL et al (2005) Phase III, randomized, double-blind study of epoetin alfa versus placebo in anemic patients with cancer undergoing chemotherapy. J Clin Oncol 23:2606–2617

    Article  PubMed  CAS  Google Scholar 

  29. Wu AW, Revicki DA, Jacobson D, Malitz FE (1997) Evidence for reliability, validity and usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Qual Life Res 6:481–493

    Article  PubMed  CAS  Google Scholar 

  30. Yancik R, Ganz PA, Varricchio CG, Conley B (2001) Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base. J Clin Oncol 19:1147–1151

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to thank George D. Demetri, M.D., of the Dana-Farber Cancer Institute, Boston, MA, for his assistance in the initial concept development for this analysis, and Yvonne Yarker, Ph.D., of Thomson Scientific Connexions, Newtown, PA, for editorial assistance in preparing this manuscript. This research was supported by Ortho Biotech Clinical Affairs, LLC. Protocol numbers for the studies analyzed are PR93-27-003, PR95-27-014, and PR97-27-042.

Author information

Authors and Affiliations

  1. Clinique de Genolier, Genolier, Switzerland

    Matti S. Aapro

  2. Division of Internal Medicine, University of Washington, Seattle, WA, USA

    David C. Dale

  3. Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ, USA

    Michael Blasi, Brenda Sarokhan & Richard C. Woodman

  4. Analysis Group, Inc., Boston, MA, USA

    Fawzia Ahmed

  5. Department of Medicine, University of Washington, Box 356422, Seattle, WA, 98195, USA

    David C. Dale

Authors
  1. Matti S. Aapro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David C. Dale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Blasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brenda Sarokhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fawzia Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard C. Woodman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David C. Dale.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aapro, M.S., Dale, D.C., Blasi, M. et al. Epoetin alfa increases hemoglobin levels and improves quality of life in anemic geriatric cancer patients receiving chemotherapy. Support Care Cancer 14, 1184–1194 (2006). https://doi.org/10.1007/s00520-006-0076-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-006-0076-z

Keywords

Search

Navigation