Advocating recombinant human erythropoietin as standard practice in Europe for treatment of cancer-related anaemia

Abstract

Anaemia is common in cancer patients and is related to the disease and the anticancer treatment given. Even at mild–moderate levels, anaemia can add to the heavy physical and psychological burden endured by cancer patients, with debilitating fatigue and other symptoms making their lives almost unbearable [1]. Importantly, anaemia has also been shown to impair survival in patients with the vast majority of types of cancer. Thus, treatment of anaemia is an important part of cancer management and doing nothing is not an option. Red blood cell transfusion offers temporary relief from anaemia, but is not usually given unless patients are severely anaemic because it is associated with unacceptable side-effects, including immune response and transmission of infectious agents, and because supplies are becoming scarce. The alternative is recombinant human erythropoietin (rhEPO, epoetin), which is effective in reversing anaemia, is free from transfusion-associated sideeffects and is less costly than transfusion when improvements in quality of life (QoL) are taken into account [2]. In the US, rhEPO is a well established part of cancer care with approximately seven or eight times more rhEPO being prescribed than in Europe, for roughly the same number of cancer patients. In fact, in the US, rhEPO is prescribed more often than granulocyte colonystimulating factor [3]. This increased use of rhEPO seems to be driven by heightened awareness among US cancer patients and physicians of the detrimental effects of anaemia on QoL and survival. In contrast, lower concern among European health care professionals, in addition to budget restrictions, leaves many European patients suffering from anaemia-related problems. Whereas the demands of patient advocacy groups in the US have resulted in improvements in anaemia treatment, such demands are expressed less strongly in Europe. Treatment of anaemia with rhEPO is becoming easier and more convenient. While rhEPO three times a week (tiw) is the established standard worldwide, administration of once a week (qw) doses of rhEPO 40000 IU is increasing, based on the results of a recent study [4]. However, this regimen is not approved by US or European health authorities. A more convenient and costeffective regimen has been evaluated by a new qw comparative study performed in 12 European countries. Epoetin β (NeoRecormon ® ) was given to anaemic patients with lymphoid malignancies either tiw (10000 IU) or qw (30 000 IU) [5]. Response to treatment (defined as ≥2 g/dl increase in haemoglobin level) was high (∼75%) and the effects of epoetin β qw were not different from those of the tiw regimen: a significant and sustained increase in haemoglobin with a reduction in transfusion use. No significant therapy-related adverse events were observed, and no patient developed antibodies to epoetin β. Based on these results, epoetin β given qw at a dose of 30 000 IU was recently approved for cancer-related anemia treatment in Europe. Given the negative impact of anaemia in cancer patients and the benefits derived from rhEPO treatment, it can no longer be justified that so few European patients are given the chance to receive this therapy, especially as a more convenient and costeffective epoetin β regimen is now available.