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Rosti G, Petrini M, Bosi A, Galieni P, Bernardi D, Giglio G, Dorotea L, Falini B, Scelzi E, Veltri E, Castelli R, Longagnani C, Raggi T, Simonetti F. Management of anaemia in oncohaematological patients treated with biosimilar epoetin alfa: results of an Italian observational, retrospective study. Ther Adv Med Oncol 2017; 9:22-32. [PMID: 28203295 PMCID: PMC5298451 DOI: 10.1177/1758834016670554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many patients with solid tumours or nonmyeloid haematopoietic tumours develop symptomatic anaemia, which has a major impact on quality of life (QoL). The efficacy of erythropoiesis-stimulating agents (ESAs) in improving QoL and reducing blood transfusions has been widely demonstrated. Binocrit® (biosimilar epoetin alfa) is an ESA indicated in the European Union for treating chemotherapy-induced anaemia. The aim of this study was to investigate the effect of Binocrit® on haemoglobin (Hb) levels in anaemic cancer patients in Italian clinical practice. METHODS The ANEMONE study was a national, longitudinal, retrospective, multicentre observational study. Patients had to be 18 years or older, with a solid tumour or non-Hodgkin's lymphoma, Hodgkin's disease or multiple myeloma, receiving chemotherapy, and treated with Binocrit® to manage chemotherapy-induced anaemia. The primary outcomes were the proportion of patients with a Hb increase ⩾1 g/dl during the first 4 weeks and with a Hb increase ⩾2 g/dl during the first 12 weeks. RESULTS A total of 245 patients were enrolled and 215 patients were evaluable for statistical analysis. In the first 4 weeks, 49.3% of patients showed an increase in Hb of ⩾1 g/dl: 45.5% in patients with solid tumours and 52.1% in patients with haematological malignancies. In the first 12 weeks, 51.6% of patients showed an increase in Hb of ⩾2 g/dl (48.4% solid tumours, 54.2% haematological diseases). Treatment with Binocrit® was well tolerated. CONCLUSIONS These results confirm the effectiveness and safety of Binocrit® for chemotherapy-induced anaemia in routine practice in patients with solid tumours, lymphoma and myeloma.
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Affiliation(s)
- Giovanni Rosti
- Oncologia, Policlinico San Matteo IRCCS, Pavia, Via Scarpa 1, 31100 Treviso, Italy
| | - Mario Petrini
- Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alberto Bosi
- Department of Hematology, Careggi Hospital and University of Florence, Firenze, Italy
| | | | | | | | | | | | - Elvira Scelzi
- Ospedale di Castelfranco Veneto (ULSS), Castelfranco Veneto, Italy
| | | | - Roberto Castelli
- Fondazione Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
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Zanini D, Pelinson LP, Schmatz R, Belmonte Pereira L, Curry Martins C, Baldissareli J, Pires Amaral G, Antunes Soares FA, Brenner Reetz LG, Araújo MDC, Chiesa J, Morsch VM, Bitencourt Rosa Leal D, Schetinger MRC. δ-aminolevulinate dehydratase activity in lung cancer patients and its relationship with oxidative stress. Biomed Pharmacother 2014; 68:603-9. [DOI: 10.1016/j.biopha.2014.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 04/16/2014] [Indexed: 12/11/2022] Open
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The anemia impact measure (AIM): development and content validation of a patient-reported outcome measure of anemia symptoms and symptom impacts in cancer patients receiving chemotherapy. Qual Life Res 2011; 21:1255-66. [DOI: 10.1007/s11136-011-0034-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2011] [Indexed: 10/17/2022]
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Gabrilove JL, Perez EA, Tomita DK, Rossi G, Cleeland CS. Assessing symptom burden using the M. D. Anderson symptom inventory in patients with chemotherapy-induced anemia: results of a multicenter, open-label study (SURPASS) of patients treated with darbepoetin-alpha at a dose of 200 microg every 2 weeks. Cancer 2007; 110:1629-40. [PMID: 17694552 DOI: 10.1002/cncr.22943] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patients with cancer who are receiving chemotherapy often experience chemotherapy-induced anemia (CIA), which is associated with symptoms that reduce quality of life. The M. D. Anderson Symptom Inventory (MDASI) is a brief, self-rating assessment scale that measures the severity of core symptoms and symptom interference with function. The current study used the MDASI to prospectively assess the correlation between hemoglobin and self-perceived cancer-related symptoms in a large patient population with CIA who were receiving darbepoetin-alpha at a dose of 200 mug every 2 weeks. METHODS Eligible patients enrolled in this multicenter, open-label study were age > or =18 years, had a nonmyeloid malignancy, were receiving multicycle chemotherapy, and were anemic (hemoglobin < or = 11 g/dL). Hemoglobin was measured every 2 weeks; the MDASI was administered weekly. For hemoglobin-based endpoints, patients were stratified by baseline hemoglobin (< 10 g/dL or > or =10 g/dL). RESULTS Of 2422 enrolled patients, 2401 received > or =1 dose of darbepoetin-alpha. Eighty percent of patients (95% confidence limit, 78-82 patients) achieved target hemoglobin levels (> or =11 g/dL) during the study. Patients with a baseline hemoglobin < 10 g/dL had a greater increase in hemoglobin, took longer to achieve the target hemoglobin, and received more red blood cell transfusions than patients with a baseline hemoglobin > or =10 g/dL. The percentage of patients with moderate to severe MDASI scores (> or =5 points) for fatigue, distress, loss of appetite, disturbed sleep, and interference with function was reduced during the study. Improvement in symptom burden was associated with an increase in hemoglobin concentration. CONCLUSIONS Treatment with darbepoetin-alpha at a dose of 200 mug every 2 weeks is associated with improvement in symptom burden as measured by the MDASI, a simple tool that may improve symptom management for cancer patients with CIA.
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Affiliation(s)
- Janice L Gabrilove
- Division of Hematology/Oncology, Mount Sinai Medical Center, New York, New York, USA
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Jacober MLV, Mamoni RL, Lima CSP, Dos Anjos BL, Grotto HZW. Anaemia in patients with cancer: role of inflammatory activity on iron metabolism and severity of anaemia. Med Oncol 2007; 24:323-9. [PMID: 17873309 DOI: 10.1007/s12032-007-0009-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 11/30/1999] [Accepted: 12/21/2006] [Indexed: 10/23/2022]
Abstract
Hepcidin has been proposed as an important factor in the pathogenesis of the anaemia of chronic disease (ACD). The aim of this study was to assess the relationship between anaemia and inflammatory activity in patients with solid tumours. Patients were classified as having iron deficiency anaemia (IDA) (hypoferremia and hypoferretinemia), ACD (hypoferremia, normal or increased serum ferritin) and anaemia related to cancer (ARC) (no abnormalities in iron status). Serum pro-hepcidin, IL-6, C-reactive protein (CRP) and iron status parameters were measured using commercial kits. CRP and IL-6 levels were significantly higher in patients with ACD when compared to IDA, ARC and non anaemic patients (P < 0.005). Serum pro-hepcidin levels were not different among all studied groups (P = 0.138). A negative correlation was observed between haemoglobin and serum ferritin, CRP and IL-6 levels only in group of ACD. Serum pro-hepcidin concentrations were not correlated with degree of anaemia or iron metabolism parameters. According to our results the inflammatory activity represented by high levels of IL-6 and CRP are involved in the pathogenesis of ACD, probably due to the action of inflammation on iron metabolism, but not in ARC. It was not possible to demonstrate a significant effect of pro-hepcidin on the anaemia in cancer patients.
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Affiliation(s)
- M L V Jacober
- Departamento de Patologia Clínica/FCM/UNICAMP, Caixa Postal 6111, Campinas, SP, Brazil
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Langer CJ, Fastenau JM, Forlenza JB, Tak Piech C, Bolge SC, Gano Allen J, Zilberberg MD. Effectiveness versus convenience: patient preferences for an erythropoietic agent to treat cancer-related anemia. Curr Med Res Opin 2007; 23:85-92. [PMID: 17257469 DOI: 10.1185/030079906x162728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess patient preferences across two attributes--effectiveness and convenience--in the selection of an erythropoietic agent to treat chemotherapy-related anemia. METHODS During 2004, 500 adults with solid tumors and anemia were recruited through 50 oncologists' offices across the USA. Data were collected through self-administered questionnaires, divided into two parts. The first, completed by the provider, captured clinical information and providers' perceptions of patient preferences. The second, completed by the patient, recorded knowledge, experiences, and preferences regarding anemia and its treatments. Patient preferences, the relative importance of effectiveness (time to noticeable relief of fatigue) and convenience (number of provider visits required in an 8-week period), were measured using a choice-based conjoint (CBC) analysis. Each attribute was assessed at three levels (4, 6, or 8 weeks/visits). RESULTS 467 providers (93%) and 438 patients (88%) completed the preference sections. When choosing a medication to treat anemia, 77% of providers viewed effectiveness as more important to patients than convenience. Similarly, patients had a greater preference for effectiveness than convenience. Relative preference weights were significantly higher for 4- versus 6-week effectiveness (0.61 vs. 0.09, p < 0.001) and 6- versus 8-week effectiveness (0.09 vs. -0.70, p = 0.004). Overall, time to effectiveness was twice as important to patients as the number of visits. LIMITATIONS Only two attributes were included in the CBC, which did not control for bias from respondent characteristics or experiences. CONCLUSION When evaluating an erythropoietic agent to treat chemotherapy-related anemia, both providers and patients view effectiveness as more important than convenience.
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Waltzman R, Croot C, Justice GR, Fesen MR, Charu V, Williams D. Randomized comparison of epoetin alfa (40,000 U weekly) and darbepoetin alfa (200 microg every 2 weeks) in anemic patients with cancer receiving chemotherapy. Oncologist 2006; 10:642-50. [PMID: 16177289 DOI: 10.1634/theoncologist.10-8-642] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This is the first randomized, open-label, multicenter trial designed and powered to directly compare the hemoglobin (Hb) response to epoetin alfa (EPO), 40,000 U once weekly (QW), with that to darbepoetin alfa (DARB), 200 microg every 2 weeks (Q2W), in anemic patients with cancer receiving chemotherapy (CT). Transfusion requirements, quality of life (QOL), and safety also were evaluated. Adults with solid tumors scheduled to receive CT for > or =12 weeks and with baseline Hb < or =11 g/dl were randomized to receive either EPO 40,000 U QW (n = 178) or DARB 200 microg Q2W (n = 180) s.c. for up to 16 weeks. Doses were increased for nonresponders (Hb increase <1 g/dl) after 4 (EPO) or 6 (DARB) weeks, as per National Comprehensive Cancer Network guidelines, and were reduced for a rapid rise in Hb (>1.3 g/dl [EPO] or >1.0 g/dl [DARB] within any 2-week period) or for an Hb level >13 g/dl. The proportion of patients achieving a > or =1-g/dl Hb rise by week 5, the primary end point, was significantly higher with EPO (47.0%) than with DARB (32.5%), and EPO-treated patients achieved a > or =1-g/dl Hb increase significantly earlier than those receiving DARB (median, 35 days versus 46 days). The mean increase in Hb from baseline was significantly higher at weeks 5, 9, 13, and the end of the study with EPO than with DARB. The number of units transfused per patient was significantly lower for the EPO group than for the DARB group. The proportions of patients requiring transfusions, mean QOL improvements, and tolerability profiles were similar in the two groups.
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Affiliation(s)
- Roger Waltzman
- St. Vincent's Comprehensive Cancer Center, New York, New York 10011, USA.
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Foubert J. New EORTC guidelines for the treatment of anaemia in patients with cancer: implications for nursing practice. Eur J Oncol Nurs 2005; 10:177-86. [PMID: 16199202 DOI: 10.1016/j.ejon.2005.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 08/23/2005] [Accepted: 08/23/2005] [Indexed: 11/22/2022]
Abstract
Anaemia and associated fatigue are common problems in patients with cancer, and fatigue is considered by patients with cancer to be their most limiting symptom. The introduction of erythropoiesis-stimulating proteins (ESPs) has greatly improved the management of anaemia; however, many European patients with cancer-related anaemia are untreated because of a lack of awareness among healthcare professionals of the benefits of anaemia treatment to patients, or because of regional differences in treatment practices. Recently, the European Organisation for Research and Treatment of Cancer (EORTC) developed the first European evidence-based guidelines for the use of ESPs in cancer-related anaemia in order to facilitate and standardize the assessment and management of the condition. These guidelines, and the implications for oncology nurses in implementing them in practice, are discussed.
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Affiliation(s)
- Jan Foubert
- Jules Bordet Institute, 1 rue Héger Bordet - Boulevard de Waterloo 121, 1000 Brussels, Belgium.
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Smyth D, Zumbrink S. Optimising the management of anaemia in patients with cancer with practice guidelines using erythropoiesis-stimulating proteins. Eur J Oncol Nurs 2005; 9 Suppl 1:S3-S13. [PMID: 16202653 DOI: 10.1016/j.ejon.2005.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 08/25/2005] [Indexed: 11/27/2022]
Abstract
Anaemia, a common problem in patients with cancer, usually leads to severe fatigue, which can dramatically impair patients' quality of life (QOL). Nurses are in the ideal position to assess and monitor cancer patients at risk of anaemia and recommend appropriate supportive care measures to alleviate anaemia-related symptoms. Erythropoiesis-stimulating proteins (ESPs) can increase haemoglobin levels, reduce the need for red blood cell transfusions, and improve QOL in patients with cancer and anaemia. Evidence-based guidelines published by national and international organisations make specific recommendations for the appropriate use of ESPs. Nurses are key members of the multidisciplinary teams that develop practice-specific protocols, which are based on the national guidelines. The practice guidelines should describe protocols to identify patients at risk for anaemia and interventions to correct anaemia, with specific details on the choice of ESP and when such interventions should be initiated and halted. In addition, nurses should also recommend strategies to reduce patient burden, such as patient self-administration with prefilled pens or synchronisation of visits for ESPs with chemotherapy visits, which is made possible with the once-every-3-weeks extended dosing with darbepoetin alfa. The implementation of such practice guidelines should improve the quality of care provided to patients.
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Affiliation(s)
- Dion Smyth
- University of Central England, 031 Bevan House, Westbourne Road, Edgbaston, Birmingham B15 3TN, UK.
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