Factors and Predictors of Response with Epoetin Alfa for Chemotherapy-Related Anemia

Abstract

Objective: To describe the value of specific factors and predictors that influence the use of epoetin alfa for anemia in adults with cancer receiving chemotherapy with or without radiation therapy. Data Sources: Data search restricted to English-language literature on epoetin alfa identified by MEDLINE searches (1990-July 2000) and other pertinent literature was conducted. Data Synthesis: Anemia of chronic disease (ACD) is a common finding among cancer patients. Patients receiving repeated or multiple chemotherapy regimens alone or with radiation therapy may worsen ACD. Blood transfusion is the cornerstone of treatment. Risks associated with allogeneic blood transfusion are clearly established. This includes alteration of the immune system, acute allergic reactions, viral and bacterial infections, tumor reappearance, and reduced quality of life (QOL). As the demand for blood increased and periodic supply shortages occurred, healthcare centers began seeking alternatives to blood transfusion. Recombinant human erythropoietin (epoetin alfa) is a prophylactic or treatment option that can reduce the need for blood transfusion with an improved QOL. Albeit clinically beneficial, epoetin alfa is expensive. Using predictors during early use with epoetin alfa, clinicians can identify patients most likely and least likely to benefit from further therapy, thus preventing costly outcomes. The change in hemoglobin (>0.5–1.0 g/dL) combined with either endogenous erythropoietin concentration (<100 mU/mL) or absolute reticulocyte count increase (>40,000 cells/uL) two to four weeks after starting therapy provided the most powerful prediction of response to epoetin alfa. Conclusions: Key factors and predictors with epoetin alfa can optimize therapy outcomes in cancer patients receiving chemotherapy.