Once-Weekly Epoetin as Good as Thrice-Weekly Dose

epoetinNovember 6 (Istanbul) — Cancer patients receiving epoetin to prevent anemia during chemotherapy or radiation treatment fared just as well on once-weekly doses as on the traditional thrice-weekly regimen, but with several advantages. In addition to being far more convenient for patients, the once-weekly regimen had a shorter duration of treatment and less need for dose escalation and probably had a better cost-effectiveness, according to a prize-winning poster presentation at the recent 31st Congress of the European Society of Medical Oncology (ESMO).

These conclusions come from a clinical trial in 409 patients reported by Jose Munoz-Langa, MD, and colleagues, from the Dr Peset University Hospital, in Valencia, Spain. These patients had a variety of solid tumors requiring chemotherapy or radiation and were given epoetin alfa either 40,000 IU once weekly or 10,000 IU 3 times weekly. Two commercial preparations of epoetin alfa are available, Procrit (Johnson & Johnson) and Epogen (Amgen), but the poster did not specify which was used.
The hematopoietic response rate was similar with both regimens (67.3% for the thrice-weekly regimen vs 71.5% for once-weekly), as was the mean hemoglobin level during epoetin treatment (11.4 g/dL vs 11.6 g/dL), and the proportion of patients who needed transfusions (13.7% vs 10.8%).

However, the mean change in hemoglobin was higher in the once-weekly group (1.9 g/dL vs 1.1 g/dL; P = .007), as was the hemoglobin level at the end of the study (11.8 g/dL vs 11.3 g/dL; P = .007). In addition, fewer patients in the once-weekly group needed a dose increase (12.3% vs 36.1%; P = 0.0001), and they had a shorter duration of treatment (6.2 weeks vs 7.2 weeks; P = .016).

Same Result, Different Product

A similar dose comparator study, using another product, was reported in a neighboring poster by Ulrich Kleeberg, MD, from Haematologisch-Onkologische Praxis Altona, in Hamburg, Germany. This study compared epoetin beta (NeoRecormon, Roche) at a dose of 30,000 IU once weekly with 10,000 IU given thrice weekly in 1458 patients. Most of these patients had solid tumors (371 had hematologic cancers) and were undergoing chemotherapy.

The extended dosing of epoetin is proven and considered as standard practice in patients with hematological cancers, but there have been little data in patients with solid tumors until now, Dr. Kleeberg commented. The results of the study he presented show that the once-weekly dosing of epoetin beta is as safe and effective in patients with solid tumors "as has already been proven in hematologic malignancies," he concluded.

Several other poster presentations reinforced the message that once-weekly epoetin was effective, although none of these others had a comparator dose. Two posters presented results from meta-analyses of epoetin alfa clinical trials. One was carried out by Pere Gascon, MD, PhD, and colleagues, from the University of Barcelona, in Spain, and involved 4296 patients with mixed tumor types, while the other, reported by Mario Dicato, MD, from the Luxembourg Medical Center, involved 2019 patients with breast cancer. Both concluded that 40,000-IU epoetin alfa is effective and well tolerated; it ameliorates the impact of chemotherapy on hemoglobin and improves quality of life, thus representing "good anemia management," the researchers concluded.

ESMO 31st Congress: Abstracts 1024P, 1023P, 1019P, and 1021P. Presented October 1, 2006.