• 11/7/2007
  • Memphis, TN
  • staff
  • CancerConsultants.com

Researchers affiliated with RTOG 99-03 study have reported that the administration of radiotherapy with or without recombinant erythropoietin alfa did not affect survival or relapse of anemic patients with head and neck cancer. The details of this study were published in the November 15, 2007 issue of the International Journal of Radiation Oncology * Biology * Physics.1

Epoetin alfa (Procrit®, Epogen®) and darbepoetin alfa (Aranesp®) have been evaluated in anemic patients with head and neck cancer receiving radiation therapy or chemoradiotherapy. The administration of erythropoietins improves hemoglobin levels and decreases transfusion requirements without having an impact on survival. However, there has been concern that erythropoietins could stimulate tumor growth and result in a higher relapse rate. In one study from Denmark in patients with head and neck cancer receiving radiotherapy, the goal was to maintain high hemoglobin levels. In this study, patients receiving prophylactic epoetin alfa to maintain high hemoglobin levels had a lower disease-free survival than patients receiving placebo.

In the current study, 141 patients with head and neck cancer receiving radiation therapy were randomly allocated to receive epoetin alfa or no epoetin alfa. Hemoglobin levels were 9.0-13.5 g/dL at baseline. Hemoglobin levels rose by 1.66 g/dL in the treatment group and decreased by 0.24 g/dL in the control group. Local failure rate was 36% for the control group and 44% for the Epo group. The 3 year local and distant PFS was 53% for the control group and 47% for the Epo group. Overall survival was 57% for the control group and 56% for the Epo group. These authors pointed out that the study was not designed to detect a negative association between Epo administration and tumor progression.

Comments:
Although this study was not designed to detect a negative effect of Epo, it did show what most studies have shown which is that Epo can increase hemoglobin levels and decrease transfusions without effect on survival. At the present time it would appear prudent to avoid high doses of Epogen or Aranesp and follow published guideless for administration.