Anaemia management with epoetin alfa in lung cancer patients in The Netherlands

Abstract

Anaemia seriously threatens the quality of life (QOL) in cancer patients receiving chemotherapy. In this article results are presented on the lung cancer population from a Dutch observational study. This study addressed the real-life situation of recombinant human erythropoietin (r-Hu-EPO or epoetin alfa) treatment in anaemic cancer patients receiving chemotherapy, with a focus on efficacy. In total 781 patients were enrolled in the observational study, including 382 patients with lung cancer. At enrolment patients were receiving epoetin alfa treatment and/or patients had a haemoglobin (Hb) level </=11.3g/dl. Analysis was focused on lung cancer patients who were treated with epoetin alfa (n=343). Type of cancer, chemotherapy agents, type of anaemia management and Hb levels were documented. Hb development was analysed and the effect of epoetin alfa treatment was investigated. In total 343 lung cancer patients were treated with epoetin alfa: 210 patients with non-small cell lung cancer (NSCLC) and 133 patients with small cell lung cancer (SCLC). The majority of patients (99.4%) received 40,000 IU epoetin alfa once weekly. Before epoetin alfa treatment was started during chemotherapy, Hb levels decreased with a rate of 1.3g/dl per 4 weeks, both for NSCLC as well as for SCLC. Epoetin alfa treatment was started on average at an Hb level of 10.6g/dl for NSCLC and 10.4g/dl for SCLC, respectively. Hb increases of 0.5-0.6g/dl per 4 weeks and 0.2g/dl per 4 weeks were reached for NSCLC and SCLC, respectively. Although significant increases of Hb levels were reached, the epoetin alfa treatment could not fully correct the Hb decrease which had taken place during chemotherapy before the start of epoetin alfa, resulting in suboptimal Hb levels. In contrast, early intervention with epoetin alfa (start in first week of chemotherapy at Hb>11.3g/dl) was especially effective for NSCLC patients where it resulted in a stabilization of Hb at baseline level. For SCLC patients this strategy was less effective. Furthermore, early intervention seemed to diminish the need for a blood transfusion, i.e., the higher the Hb at epoetin initiation the more patients did not receive any blood transfusion. Results from this observational study demonstrate that epoetin alfa treatment corrects chemotherapy-related anaemia in both NSCLC as well as SCLC patients. Early epoetin alfa intervention seems advantageous for lung cancer patients both in terms of maintaining adequate Hb levels during chemotherapy as well as reducing transfusions.