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Intravenous Iron Supplementation for the Treatment of Chemotherapy-Induced Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2022; 11:jcm11144156. [PMID: 35887920 PMCID: PMC9317757 DOI: 10.3390/jcm11144156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background: The pathophysiology of cancer-related anemia is multifactorial, including that of chemotherapy-induced anemia (CIA). The guidelines are not consistent in their approach to the use of intravenous (IV) iron in patients with cancer as part of the clinical practice. Materials and methods: All randomized controlled trials that compared IV iron with either no iron or iron taken orally for the treatment of CIA were included. We excluded trials if erythropoiesis-stimulating agents (ESAs) were used. The primary outcome was the percentage of patients requiring a red blood cell (RBC) transfusion during the study period. The secondary outcomes included the hematopoietic response (an increase in the Hb level by more than 1 g/dL or an increase above 11 g/dL), the iron parameters and adverse events. For the dichotomous data, risk ratios (RRs) with 95% confidence intervals (Cis) were estimated and pooled. For the continuous data, the mean differences were calculated. A fixed effect model was used, except in the event of significant heterogeneity between the trials (p < 0.10; I2 > 40%), in which we used a random effects model. Results: A total of 8 trials published between January 1990 and July 2021 that randomized 1015 patients fulfilled the inclusion criteria. Of these, 553 patients were randomized to IV iron and were compared with 271 patients randomized to oral iron and 191 to no iron. IV iron decreased the percentage of patients requiring a blood transfusion compared with oral iron (RR 0.72; 95% CI 0.55−0.95) with a number needed to treat of 20 (95% CI 11−100). IV iron increased the hematopoietic response (RR 1.23; 95% CI 1.01−1.5). There was no difference with respect to the risk of adverse events (RR 0.97; 95% CI 0.88−1.07; 8 trials) or severe adverse events (RR 1.09; 95% CI 0.76−1.57; 8 trials). Conclusions: IV iron resulted in a decrease in the need for RBC transfusions, with no difference in adverse events in patients with CIA. IV iron for the treatment of CIA should be considered in clinical practice.
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2
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Tan J, Du S, Zang X, Ding K, Ginzburg Y, Chen H. The addition of oral iron improves chemotherapy-induced anemia in patients receiving erythropoiesis-stimulating agents. Int J Cancer 2022; 151:1555-1564. [PMID: 35639027 DOI: 10.1002/ijc.34142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/07/2022]
Abstract
Although many studies have shown that supplementation with iron and erythropoiesis-stimulating agents (ESA) is frequently used for managing chemotherapy-induced anemia (CIA), optimal combination therapy using these agents together to ameliorate anemia is not well characterized. To assess the effects of ESA combined with oral or intravenous (IV) iron on relieving CIA, PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) were searched for articles. Data collected in the articles were meta-analyzed using RevMan 5.3 software with a random-effects model. Our comprehensive search yielded 1666 potentially relevant trials. A total of 41 trials randomizing 4200 patients with CIA fulfilled inclusion criteria, including 34 Chinese articles and 7 English articles. Meta-analysis showed that treatment with both ESA and iron more effectively improved CIA relative to iron supplementation alone, with increased hemoglobin, hematocrit, red blood cell count and haematopoietic response rate. Subgroup analyses revealed iron administration, both oral and IV iron, improved anemia in ESA-treated cancer patients with CIA. Our analysis demonstrates that iron supplementation combined with ESA more effectively ameliorates CIA relative to iron supplementation alone, without regard to whether IV or oral iron was used. Together, our findings may contribute to the clinical treatment of CIA using iron therapy with or without ESA. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jingyong Tan
- Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
| | - Sitong Du
- Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
| | - Xueyan Zang
- Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Kaiyue Ding
- Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yelena Ginzburg
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Huiyong Chen
- Molecular Biology Research Center and Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
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3
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Krishnan S, Sarda S, Kunzweiler C, Wu M, Sundaresan S, Huynh L, Duh MS, Escalante CP. Literature Review of Fatigue Scales and Association with Clinically Meaningful Improvements in Outcomes Among Patients With and Without Paroxysmal Nocturnal Hemoglobinuria. Adv Ther 2022; 39:1959-1975. [PMID: 35316499 PMCID: PMC9056457 DOI: 10.1007/s12325-022-02111-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
Abstract
Introduction Paroxysmal nocturnal hemoglobinuria (PNH) is a rare blood disorder characterized by anemia and debilitating fatigue. Limited evidence characterizes the association between hemoglobin, an indicator of anemia and disease activity, and patient-reported fatigue scales. This review identifies benchmarks for clinically meaningful improvements in patients with and without PNH. Methods MEDLINE, Embase, Cochrane, and PsycINFO databases were searched along with Google Scholar to identify publications for patients with and without PNH. Full-text articles and conference abstracts of clinical trials or observational studies that examined patient-reported fatigue or associations between fatigue and hemoglobin were included. Results Fourteen publications were included in this study. Four clinical trials conducted in patients with PNH reported that patients achieved and sustained clinically meaningful improvements in fatigue. However, these studies did not examine the association between fatigue and hemoglobin. Ten studies conducted in patients with cancer and anemia (with or without chemotherapy) demonstrated an association between increased hemoglobin and improvements in fatigue (P < 0.05). The greatest incremental gain in fatigue improvement was observed when hemoglobin increased from 11 to 12 g/dL. Conclusion Evidence among patients with cancer without PNH demonstrates that increased hemoglobin levels are associated with clinically significant improvements in fatigue. Future studies should validate this relationship among patients with PNH. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02111-7.
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Wilkie DJ, Schwartz AL, Liao WC, Fullwood D, Wu Y, Farquharson TW, Yao Y, Gralow JR. Reduced Cancer-Related Fatigue after Tablet-Based Exercise Education for Patients. Cancer Control 2022; 29:10732748221087054. [PMID: 35414203 PMCID: PMC9014720 DOI: 10.1177/10732748221087054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM Exercise can be an effective treatment for cancer-related fatigue, but exercise is not prescribed for many cancer patients. Our specific aim was to compare usual care and a tablet-based fatigue education and prescription program for effects on level of fatigue (primary outcome) and satisfaction with fatigue and amount of exercise (secondary outcomes). METHODS In a four-week pretest/posttest randomized study, 279 patients with cancer completed a touch screen fatigue assessment and daily paper-based activity logs. The experimental group also had access to FatigueUCope, a tablet-based multimedia education intervention focused on exercise as therapy for fatigue. RESULTS In total, 94% of intervention group accessed FatigueUCope. Controlling for baseline fatigue, compared to the usual-care group, the experimental group reported lower fatigue scores (P = .02). Neither satisfaction with fatigue nor exercise level was significantly different between groups, but not all activity logs were returned. None of the patients reported adverse effects. CONCLUSION Objective indicators of exercise are warranted in future studies to examine whether exercise is indeed the mechanism of the FatigueUCope effect and determine the clinical utility of this intervention. This brief, engaging tablet-based multimedia education and prescription program has promise to help patients recognize the benefits of exercise to manage cancer-related fatigue.
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Affiliation(s)
- Diana J. Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Anna L. Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, AZ, USA
| | - Wen-Chun Liao
- School and Graduate Institute of Nursing, China Medical University, Taichung, China
| | - Dottington Fullwood
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Yu Wu
- Department of Advanced Heart Failure and Heart Transplant, University of Florida Health, Gainesville, FL, USA
| | - Tanya Wallace Farquharson
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Julie R. Gralow
- Department of Medicine/Oncology, University of Washington, Seattle, WA, USA
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Abdel-Razeq H, Saadeh SS, Malhis R, Yasser S, Abdulelah H, Eljaber R, Kleib A, Ismael R. Treatment of anemia in cancer patients undergoing chemotherapy with intravenous ferric carboxymaltose without erythropoiesis-stimulating agents. Ther Adv Med Oncol 2020; 12:1758835920953292. [PMID: 32952616 PMCID: PMC7485004 DOI: 10.1177/1758835920953292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Anemia is commonly encountered in cancer patients receiving active
chemotherapy. Due to adverse events and presumed negative effects on
disease-progression and survival, erythropoiesis-stimulating agents are not
frequently used. In this study, we assess the efficacy and safety of
intravenous ferric carboxymaltose (FCM) to treat cancer-induced anemia
(CIA). Patients and Methods: We recruited adult cancer patients on active chemotherapy with a hemoglobin
(Hb) level ⩽11.0 g/dL. Based on serum ferritin (sFr) and transferrin
saturation (TSAT), patients were divided into 3 groups: group I (absolute
iron deficiency, n = 26) with sFr < 30 ng/mL and
TSAT < 20%; group II (functional iron deficiency,
n = 24) with sFr 30–800 ng/mL and TSAT < 20%; and
patients with TSAT ⩾ 20% were placed in group III as “others”
(n = 34). All patients were treated with intravenous
FCM. Serum hepcidin and C-reactive protein were used as biomarkers to
predict response. Results: A total of 84 patients with a median age (SD) of 53.8 (10.6) were recruited.
Baseline median Hb level was 10.2 (range: 8.3–11.0) gm/dL. At week 12, there
was a significant increment in Hb level for patients in groups I and II
(median increment: 2.35 and 1.5 gm/dL, respectively), with limited response
observed in group III, and most of the increment noted as early as week 3
(⩾1.0 g/dL). Responders tended to have lower levels of hepcidin. No
clinically significant adverse events were reported; however, asymptomatic
hypophosphatemia was observed in 39 (46.4%) patients. Conclusions: Intravenous FCM is a safe and effective treatment option for the management
of a subgroup of patients with CIA. The study was registered at ClinicalTrials.gov [Identifier: NCT04246021]
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Affiliation(s)
| | - Salwa S. Saadeh
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Razan Malhis
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Sameer Yasser
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- Department of Medical oncology, King Hussein
Cancer Center, Amman, Jordan
| | - Rana Eljaber
- Department of Pharmacy, King Hussein Cancer
Center, Amman, Jordan
| | - Amer Kleib
- Department of Nursing, King Hussein Cancer
Center, Amman, Jordan
| | - Rouba Ismael
- Office of Scientific Affairs and Research, King
Hussein Cancer Center, Amman, Jordan
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6
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Jang JH, Kim Y, Park S, Kim K, Kim SJ, Kim WS, Jung CW, Lee J, Lee SH. Efficacy of intravenous iron treatment for chemotherapy-induced anemia: A prospective Phase II pilot clinical trial in South Korea. PLoS Med 2020; 17:e1003091. [PMID: 32511251 PMCID: PMC7279571 DOI: 10.1371/journal.pmed.1003091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anemia is the most common and serious cancer-related complication. This study aimed to evaluate the efficacy of administration of ferric carboxymaltose without erythropoiesis-stimulating agents for treating anemia in cancer patients. Moreover, we identified the biomarkers of hemoglobin response to predict the need for iron therapy. METHODS AND FINDINGS We enrolled patients with solid cancers who were treated at a single institute (Samsung Medical Center, South Korea), from April 2015 to July 2017, in this prospective single-arm Phase II clinical trial. Patients received intravenous ferric carboxymaltose (1,000 mg) infusion on the first day (visit 1) of treatment. The primary end point was the number of hemoglobin responders, defined as patients with an increase in hemoglobin level ≥ 1.0 g/dL from the baseline, a hemoglobin level ≥ 11.0 g/dL, or both, within an 8-week observation period (week 3, 6, or 8). Secondary end points included changes in transferrin saturation and levels of soluble transferrin receptors, hepcidin, erythropoietin, interleukin-6, and C-reactive protein (CRP) at each visit. Of the 103 recruited patients, 92 were eligible for analysis. The mean patient age was 57.3 ± 12.5 years, and 54.3% of the patients were women. The most common diagnoses were breast cancer (n = 23, 25.1%), lung cancer (n = 21, 22.9%), gastrointestinal cancer (n = 20, 20.9%), and lymphoma (n = 16, 17.7%). A hemoglobin response was observed in 36 (39.1%), 53 (57.6%), and 61 (66.3%) patients in the third, fifth, and eighth weeks, respectively. The mean increase in hemoglobin levels from the baseline to the end of treatment was 1.77 ± 1.30 g/dL. Baseline values of hepcidin (p = 0.008), total iron binding capacity (p = 0.014), ferritin (p = 0.048), and CRP (p = 0.044) were significantly different between the responder and nonresponder groups. Multiple logistic regression analysis for baseline anemia-related biochemical variable significantly associated with the hemoglobin response showed that only baseline hepcidin level was a significant factor for hemoglobin response (odds ratio = 0.95, 95% confidence interval 0.90-1.0, p = 0.045). Hemoglobin responders had significantly lower hepcidin levels than nonresponders (mean [±standard deviation], 13.45 [±14.71] versus 35.22 [±40.470 ng/ml]; p = 0.007). However, our analysis had some limitations such as the different patient characteristics in the studies that were included, institutional differences in the measurement of hepcidin level, and missing data on long-term safety. Therefore, our findings need further validation. CONCLUSIONS Intravenous ferric carboxymaltose (1,000 mg) monotherapy increases hemoglobin levels without serious adverse events in patients with cancer. Hepcidin is a useful biomarker for predicting iron requirement in cancer patients. TRIAL REGISTRATION Clinicaltrials.gov NCT02599012.
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Affiliation(s)
- Jun Ho Jang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Youjin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea.,Division of Hematology-Oncology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Silvia Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Chul Won Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
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7
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Abdel-Razeq H, Hashem H. Recent update in the pathogenesis and treatment of chemotherapy and cancer induced anemia. Crit Rev Oncol Hematol 2019; 145:102837. [PMID: 31830663 DOI: 10.1016/j.critrevonc.2019.102837] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Cancer and chemotherapy-induced anemia (CIA) is commonly encountered among patients undergoing active chemotherapy with or without radiation therapy. Its pathogenesis is complex and is often difficult to identify. Symptoms related to CIA may have a negative impact on quality of life and may influence treatment efficacy, disease progression and even survival. The recent major setback of erythropoietin-stimulating agents (ESAs) and the reluctance to transfuse cancer patients with mild and even moderate anemia, had resulted in significant under-treatment of CIA. The discovery of hepcidin and its role in iron homeostasis has revolutionized our understanding of the pathogenesis of iron deficiency and iron overload states. In the present review we examine the multifactorial pathogenesis of CIA, addressing the main mechanisms by which the tumor and immune system affect anemia. Additionally, we discuss the treatment options with more focus on the utilization of the new intravenous iron formulations for this indication.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Departments of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
| | - Hasan Hashem
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
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8
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Abiri B, Vafa M. Iron Deficiency and Anemia in Cancer Patients: The Role of Iron Treatment in Anemic Cancer Patients. Nutr Cancer 2019; 72:864-872. [PMID: 31474155 DOI: 10.1080/01635581.2019.1658794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Anemia is a prevalent complication in patients with cancer, both at diagnosis and during treatment, with notable negative effects on quality of life and overall prognosis. Iron deficiency is the most common cause of anemia in the patients and can affect almost half of patients with solid and hematologic malignancies. The pathogenesis is complex and multifactorial, including bleeding, malnutrition, medications, and inflammation resulted from cancer and cancer treatment. In fact, either absolute or functional iron deficiency can occur. Most iron deficient cancer patients present with functional iron deficiency, a condition with adequate iron storage but insufficient iron supply for erythroblasts and other iron dependent tissues. Functional iron deficiency is the result of the cancer related cytokine release, but in absolute iron deficiency iron reserves are depleted leading to similar but often more severe symptoms of inadequate iron store. Current therapeutic options in cancer anemia consist of iron administration, erythropoietic stimulating agents, and blood transfusion. The latter should be administered to a minimum, because of problems regarding risks. Here, we present a review on the epidemiology, pathophysiology, clinical outcomes, and therapeutic options of iron deficiency as well as the effect of iron therapy on tumor progression in anemic cancer patients.
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Affiliation(s)
- Behnaz Abiri
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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9
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Liao M, Xie Y, Yan J, Lin T, Ji S, Li Z, Zhao W, Yang Y, Lin L, Lin J. Effect of acupuncture at 3 anti-fatigue acupoints in the treatment of cancer-related fatigue in patients with cancer: Protocol for a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e15919. [PMID: 31169708 PMCID: PMC6571244 DOI: 10.1097/md.0000000000015919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF), is a common distressing symptom of cancer. What's more, "Three anti-fatigue acupoints" is one of the most important components of "Jin's 3-needle therapy" created by Rui Jin, a professor of Guangzhou University of Chinese Medicine, which can be used in the treatment of CRF. In this article, researchers will assess the safety and effect of acupuncture at 3 anti-fatigue acupoints on CRF in patients with cancer. METHODS Literature search for relevant articles up to October 2018 will be carried out in 9 databases: Cochrane Library, Embase, PubMed, VIP, CBM, CNKI, Wanfang Database, CiNii, and OASIS. The included literatures will be randomized controlled trials of acupuncture at 3 anti-fatigue acupoints on CRF in patients with cancer. The certain common scales, which reflect the patients' fatigue degree or life quality will be the primary outcome measures. The secondary outcome measures will be defined with the blood index. After collecting the data, we will utilize Stata V.13.0. to perform data synthesis, subgroup analysis, partial sequence analysis, sensitivity analysis, and so on. A funnel plot will be used to assess reporting biases. And the funnel plot will be evaluated by the Egger and Begg tests. The quality of evidence will be judged by the grading of recommendations assessment, development, and evaluation. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION Our study will provide the evidence for the clinical efficacy and safety of acupuncture at 3 anti-fatigue acupoints in the treatment of CRF.
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Affiliation(s)
- Muxi Liao
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Yizi Xie
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Jiao Yan
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Tong Lin
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Shuliang Ji
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Zongyao Li
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | | | - Yaqin Yang
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Lizhu Lin
- Oncology Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jietao Lin
- Oncology Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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10
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Chang Lee R, Sukumaran S, Koczwara B, Woodman R, Kichenadasse G, Roy A, Vatandoust S, Karapetis C. Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma. Cancer Rep (Hoboken) 2019; 2:e1148. [PMID: 32721085 PMCID: PMC7941485 DOI: 10.1002/cnr2.1148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Supportive care of Jehovah's Witnesses (JWs) diagnosed with cancer can be challenging, as they do not accept red blood cell (RBC) transfusions. AIM The study was designed to determine treatment preferences and pattern of care offered to JWs diagnosed with cancer and its impact on cancer management. METHODS AND RESULTS A retrospective cohort study of JWs with solid malignancies or lymphoma in our institution between 2005 and 2015 was conducted. Survival statistics were estimated using Kaplan Meier survival curves and Cox proportional regression model. A total of 63 JWs were identified with a median age of 70 years. At diagnosis, 34% (n = 22) had anaemia. All 63 declined RBC transfusion, including 19 patients who later developed transfusion threshold during anti-cancer treatment. Forty-three percent (n = 27) JWs had advanced (stage 4) disease, and 76% (n = 48) had Eastern Cooperative Oncology Group of 0 to 1. JWs were willing to accept surgery and radiation rather than chemotherapy. Treatment was deemed to be suboptimal in 22% (n = 14) JWs due to early treatment discontinuation, administration of non-standard chemotherapy regimen, or dose reduction due to anaemia and denial of blood transfusion. Twenty-seven percent (n = 17) received hematopoietic growth factors (erythropoiesis-stimulating agents and pegfilgrastim). There was no mortality directly attributed to anaemia or refusal of blood transfusion in the entire cohort. CONCLUSION Jehovah's Witnesses declined RBC transfusion at diagnosis and during cancer therapy even if medically indicated. Management pathways need to be prospectively defined for this group of patients.
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Affiliation(s)
| | - Shawgi Sukumaran
- Flinders Medical Centre, FCICBedford ParkSA5042Australia
- Flinders UniversityBedford ParkSA5042Australia
| | - Bogda Koczwara
- Flinders Medical Centre, FCICBedford ParkSA5042Australia
- Flinders UniversityBedford ParkSA5042Australia
| | | | - Ganessan Kichenadasse
- Flinders Medical Centre, FCICBedford ParkSA5042Australia
- Flinders UniversityBedford ParkSA5042Australia
| | - Amitesh Roy
- Flinders Medical Centre, FCICBedford ParkSA5042Australia
- Flinders UniversityBedford ParkSA5042Australia
| | - Sina Vatandoust
- Flinders Medical Centre, FCICBedford ParkSA5042Australia
- Flinders UniversityBedford ParkSA5042Australia
| | - Chris Karapetis
- Flinders Medical Centre, FCICBedford ParkSA5042Australia
- Flinders UniversityBedford ParkSA5042Australia
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11
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Aapro M, Beguin Y, Bokemeyer C, Dicato M, Gascón P, Glaspy J, Hofmann A, Link H, Littlewood T, Ludwig H, Österborg A, Pronzato P, Santini V, Schrijvers D, Stauder R, Jordan K, Herrstedt J. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv96-iv110. [PMID: 29471514 DOI: 10.1093/annonc/mdx758] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- M Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Y Beguin
- University of Liège, Liège
- CHU of Liège, Liège, Belgium
| | - C Bokemeyer
- Department of Oncology, Hematology and BMT with Section Pneumology, University of Hamburg, Hamburg, Germany
| | - M Dicato
- Hématologie-Oncologie, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - P Gascón
- Department of Haematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - J Glaspy
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - A Hofmann
- Medical Society for Blood Management, Laxenburg, Austria
| | - H Link
- Klinik für Innere Medizin I, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - T Littlewood
- Department of Haematology, John Radcliffe Hospital, Oxford, UK
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - A Österborg
- Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
| | - P Pronzato
- Medica Oncology, IRCCS Asiana Pedaliter Universitaria San Martino - IST, Institutor Nazionale per la Ricercars sol Chancre, Genova
| | - V Santini
- Department of Experimental and Clinical Medicine, Haematology, University of Florence, Florence, Italy
| | - D Schrijvers
- Department of Medical Oncology, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - R Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - K Jordan
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Herrstedt
- Department of Oncology, Zealand University Hospital Roskilde, Roskilde
- University of Copenhagen, Copenhagen, Denmark
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12
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Ng O, Keeler B, Simpson JA, Madhusudan S, Brookes M, Acheson A. Feasibility of Intravenous Iron Isomaltoside to Improve Anemia and Quality of Life During Palliative Chemotherapy for Esophagogastric Adenocarcinoma. Nutr Cancer 2018; 70:1106-1117. [DOI: 10.1080/01635581.2018.1504090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Oliver Ng
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Barrie Keeler
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - John Alastair Simpson
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Srinivasan Madhusudan
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | | | - Austin Acheson
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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13
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Arslan M, Evrensel T, Kurt E, Demiray M, Gonullu G, Kanat O, Manavoglu O. Comparison of Clinical Outcomes of Different Erythropoietin Usage Strategies. TUMORI JOURNAL 2018; 90:394-8. [PMID: 15510982 DOI: 10.1177/030089160409000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim There is no comprehensive study that compares the different usage strategies of recombinant human erythropoietin (rHuEPO) in platinum-induced anemia. In order to clarify this issue, we conducted a prospective clinical study. Material and methods Seventy-seven patients were studied in three main groups. Group 1 (n = 17) consisted of cancer patients without anemia. These patients received rHuEPO starting from the first chemotherapy cycle. Group 2 (n = 26) consisted of patients whose hemoglobin (Hb) values decreased by at least 1 g/dL after the first cycle of chemotherapy. Group 3 (n = 34) consisted of patients whose Hb values dropped below 10.5 g/dL after the second chemotherapy cycle. Groups 2 and 3 were each divided into two subgroups. In groups 1, 2A and 3A rHuEPO (5000 U/day subcutaneously three times a week) treatment was continued until three weeks after the completion of chemotherapy. In groups 2B and 3B, rHuEPO was given for 12 weeks only. Results There were no prominent differences between the Hb values of these groups throughout the chemotherapy cycles. Transfusion rates and the number of patients who became anemic were also not different between groups. Conclusion No rHuEPO usage strategies are superior to others in terms of Hb levels and transfusion requirements. The decision as to when rHuEPO is to be added to platinum-containing therapy should be tailored to the health conditions of individual patients.
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Affiliation(s)
- Murat Arslan
- Uludag University Faculty of Medicine, Department of Medical Oncology, Bursa, Turkey.
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14
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Bajetta E, Vercammen E, Reinhardt U, Janmohamed R, da Costa RM, Matulonis U, Guastalla JP. Efficacy of Epoetin Alfa in a Retrospective Non-stratified Subgroup Analysis of a Breast Cancer Cohort Receiving Non-platinum Chemotherapy. TUMORI JOURNAL 2018; 90:449-57. [PMID: 15656327 DOI: 10.1177/030089160409000501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background More than 60% of patients with metastatic breast cancer receiving non-platinum-based chemotherapy experience anemia, which is associated with fatigue and impaired quality of life. Epoetin alfa treatment in patients with a variety of malignancies has been shown to decrease transfusion requirements and improve hemoglobin levels and quality-of-life efficacy parameters. Patients Retrospective subgroup analyses were performed in patients with breast cancer who were part of a multinational, randomized (2:1), double-blind, placebo-controlled trial of anemic cancer patients (n = 375) undergoing non-platinum-based chemotherapy. Results In the breast cancer subpopulation (n = 114, 48% with stage IV disease at baseline), the hemoglobin increase was greater for epoetin alfa patients than placebo patients (2.3 versus 0.9 g/dL). Epoetin alfa patients had lower transfusion requirements (28.2% versus 33.3%), improvement or preservation versus deterioration of quality of life, and a higher proportion of responders (patients achieving a ≥2 g/dL increase in hemoglobin levels unrelated to transfusion) (68.0% versus 22.9% for placebo). The results were similar to those observed in the full study cohort, where statistical analyses showed the differences to be significant (P <0.05 for all). Epoetin alfa treatment was well tolerated. Although the study was not designed or powered for survival as an endpoint, Kaplan-Meier estimates for the full cohort showed a trend in overall survival favoring epoetin alfa treatment (P= 0.13, log rank test); a similar benefit was seen in the breast cancer subpopulation. Conclusions In the full study cohort and the breast cancer subpopulation, epoetin alfa effectively treated anemia (increased hemoglobin levels and decreased transfusion requirements) and improved or preserved quality of life. Results concerning potential survival benefits support further study of epoetin alfa in anemic cancer patients.
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Affiliation(s)
- Emilio Bajetta
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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15
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Transfusion practice patterns in patients with anemia receiving myelosuppressive chemotherapy for nonmyeloid cancer: results from a prospective observational study. Support Care Cancer 2018; 26:2031-2038. [PMID: 29349622 PMCID: PMC5919983 DOI: 10.1007/s00520-017-4035-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/28/2017] [Indexed: 01/28/2023]
Abstract
Purpose The decision to prescribe packed red blood cell (PRBC) transfusions in patients with chemotherapy-induced anemia (CIA) includes assessment of clinical features such as the patient’s cancer type and treatment regimen, severity of anemia symptoms, and presence of comorbidities. We examined contemporary transfusion practices in patients with nonmyeloid cancer and CIA. Methods Key inclusion criteria were age ≥ 18 years with nonmyeloid cancer, receiving first/second-line myelosuppressive chemotherapy, baseline hemoglobin (Hb) ≤ 10.0 g/dL, and planned to receive ≥ 1 PRBC transfusions. Exclusion criteria were receipt of erythropoiesis-stimulating agents within 8 weeks of screening and/or chronic renal insufficiency. Data were collected from patients’ medical records, laboratory values, and physician/provider questionnaires. Proportion of patients for each clinical consideration leading to a decision to prescribe a PRBC transfusion and 95% exact binomial confidence intervals were determined. Results The study enrolled 154 patients at 18 sites in USA; 147 (95.5%) received a PRBC transfusion. Fatigue was the most common symptom affecting the decision to prescribe a PRBC transfusion (101 [69.2%] patients). Of the three reasons selected as primary considerations for prescribing a PRBC transfusion, anemia symptoms (106 [72.1%] patients) was the most frequently reported, followed by Hb value (37 [25.2%] patients) and medical history (4 [2.7%] patients). Conclusions In this study, the primary consideration for prescribing a PRBC transfusion was anemia symptoms in 72.1% of patients, with only 25.2% of patients prescribed a transfusion based exclusively on Hb value. Results indicate that clinical judgment and patient symptoms, not just Hb value, were used in decisions to prescribe PRBC transfusions. Electronic supplementary material The online version of this article (10.1007/s00520-017-4035-7) contains supplementary material, which is available to authorized users.
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17
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Hematologic Manifestations of HIV/AIDS. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Gascón P, Arranz R, Bargay J, Ramos F. Fatigue- and health-related quality-of-life in anemic patients with lymphoma or multiple myeloma. Support Care Cancer 2017; 26:1253-1264. [PMID: 29116407 DOI: 10.1007/s00520-017-3948-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe perceptions of fatigue in anemic patients with lymphoma or multiple myeloma (MM). METHODS This is an observational multicenter study in a prospective cohort of lymphoma and MM patients with hemoglobin ≤ 11 g/dl managed under clinical practice. Fatigue was assessed at baseline and after 3 months using the PERFORM questionnaire, the Functional Assessment of Cancer Therapy-Fatigue, the linear analogue self-assessment, and visual analogue scale (VAS) scales. RESULTS Two hundred and fifty patients (125 with lymphoma, 125 with MM) were included. Only 59.2 and 56.0% of patients received treatment for anemia, respectively. After 3 months, the hemoglobin levels increased significantly compared to baseline from 10.0 ± 1.2 to 11.5 ± 1.8 in the lymphoma group and from 9.9 ± 0.9 to 10.9 ± 1.5 g/dl, in the MM group (P < 0.001, both comparisons). At baseline, 87.2 and 84.8% of patients had fatigue (median intensity (VAS) 60 and 50). The overall PERFORM score decreased from 35.2 ± 15.2 to 32.0 ± 14.6 (P = 0.048), without differences between groups. No statistically significant changes were observed in the other scales. After multivariable adjustment, the only common independent factor associated to improvements in fatigue and health-related quality-of-life (HRQoL) was an increase in hemoglobin levels. The administration of curative intention treatment was also associated with HRQoL improvements. The psychometric properties of the PERFORM questionnaire in MM patients were good (Cronbach's alpha 0.87-0.98; intraclass correlation coefficients 0.84-0.89; effect sizes 0.59-0.96). CONCLUSIONS Almost all patients with lymphoma or MM diagnosed with anemia suffered from fatigue of moderate to severe intensity. Despite similar anemia supportive treatment, better correction of fatigue scores was observed in lymphoma patients after 3 months. Increases in hemoglobin were significantly associated to improvements in fatigue and HRQoL.
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Affiliation(s)
- Pere Gascón
- Hospital Clínic, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - Reyes Arranz
- Hospital Universitario de La Princesa, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Joan Bargay
- Hospital Son Llatzer, Carretera de Manacor, Km. 4, 07198, Palma de Mallorca, Spain
| | - Fernando Ramos
- Hospital Universitario de León, Calle Altos de Nava, s/n, 24008, Leon, Spain
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Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis. Med Oncol 2017; 34:174. [DOI: 10.1007/s12032-017-1021-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/17/2017] [Indexed: 12/12/2022]
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Abstract
BACKGROUND Anemia is an issue of concern in the management of older patients with cancer. In this age group, the incidence and prevalence of both cancer and anemia increase with age. METHODS The clinical consequences and the management of anemia, a common comorbid condition in older patients with cancer, are explored. RESULTS Common causes of chronic anemia include iron deficiency and anemia of chronic disease. The prevalence of vitamin B12 deficiency due to reduced absorption of food-bound vitamin B12 also increases with aging. Although in many cases the cause of anemia is not found, a primary deficiency of erythropoietin may be at fault in at least some of these cases since the response of erythropoietin to anemia may decrease in individuals over age 70. CONCLUSIONS Anemia should not necessarily be ascribed to cancer or aging. The causes of anemia should be pursued and reversed, and hemoglobin levels should be maintained at a minimum of 12 g/dL in cancer patients undergoing chemotherapy who are responsive to erythropoietin. The reversal of anemia may offset or delay the accumulation of catabolic cytokines that may be responsible for functional decline in aging individuals.
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Affiliation(s)
- Lodovico Balducci
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center Research Institute, Tampa, FL 33612, USA.
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21
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Fabi A, Falcicchio C, Giannarelli D, Maggi G, Cognetti F, Pugliese P. The course of cancer related fatigue up to ten years in early breast cancer patients: What impact in clinical practice? Breast 2017; 34:44-52. [PMID: 28500901 DOI: 10.1016/j.breast.2017.04.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022] Open
Abstract
Little is known about the cancer related fatigue (CRF) along cancer course and risk factors that could predict CRF development and persistence in breast cancer (BC) survivors. This prospective study detected incidence, timing of onset, duration of CRF, impact on QoL and psychological distress. Seventy-eight early BC patients, undergoing chemotherapy (CT) followed or not by hormonal therapy were assessed for QoL and psychological distress by EORTC QLQC30 and HADs questionnaires. Fatigue was investigated with mix methods, structured interview and psychometric measures. A qualitative analysis was added to assess the behavioral pattern of CRF. Low fatigue levels were identified after surgery (9%), increasing during (49%) and at the end of CT (47%), maintaining after 1 year (31%) and declining up to ten years of follow-up. Prevalence of CRF was higher at the end of CT and lower at follow-up. At the end and after 1 and 2 years from CT, persistence of CRF was associated to anxiety in 20%, 11% and 5% and to depression in 15%, 10% and 5% respectively. A relationship between CRF and psychological distress was observed; patients presenting depression and anxiety before CT were at higher risk for fatigue onset at a later period. A relationship between fatigue and QoL was noted at the end of CT. Our study shows the fatigue timely trend in early BC patients from surgery, CT and follow-up. Identification of biological, psychological, social predictor factors related to fatigue could be helpful for early interventions in patients at higher risk of developing fatigue.
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Affiliation(s)
- Alessandra Fabi
- Regina Elena National Cancer Institute, Division of Medical Oncology 1, via Elio Chianesi 53, 00124, Rome, Italy.
| | - Chiara Falcicchio
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
| | - Diana Giannarelli
- Regina Elena National Cancer Institute, Biostatistic Unit, via Elio Chianesi 53, 00124, Rome, Italy
| | - Gabriella Maggi
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
| | - Francesco Cognetti
- Regina Elena National Cancer Institute, Division of Medical Oncology 1, via Elio Chianesi 53, 00124, Rome, Italy
| | - Patrizia Pugliese
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
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Killian AD, Gupta V, Goetz AE. Cost Analysis of Erythropoietic-Stimulating Therapy Dosing in Oncology Inpatients. Ann Pharmacother 2016; 40:421-6. [PMID: 16507613 DOI: 10.1345/aph.1g453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Inpatient costs associated with different erythropoietic-stimulating therapy regimens have not been compared in an oncology setting. Objective: To conduct a cost analysis of different regimens of epoetin alfa (EPO) and darbepoetin alfa (DARB) in an inpatient oncology setting. Methods: A retrospective evaluation of oncology diagnosis-related group discharges during 2003, in 30 community hospitals, identified EPO treatment patterns. Wholesale acquisition costs were determined for patients who received EPO 40 000 units or more once weekly. Potential differences in costs were calculated using conversion ratios for an equivalent EPO dose 3 times weekly or DARB dose once weekly (EPO:DARB ratio 260:1, approximating DARB 150 μg once weekly). A sensitivity analysis was performed using an EPO:DARB ratio of 400:1, approximating DARB 100 μg once weekly (1.5 μg/kg). Results: Among the 1410 EPO doses administered (n = 677 pts.), a dose of 40000 units or more was used 44% of the time (n = 311 pts.), with dosing initiated on average 5.6 days after admission. For these 311 evaluable patients, switching from EPO 40 000 units once weekly to EPO 10 000 units 3 times weekly reduced per-patient and total drug acquisition costs by approximately 50% ($704 vs $359 and $218 938 vs $111 615, respectively). Relative to EPO once weekly, switching patients to DARB resulted in increased drug acquisition costs at the 260:1 conversion and lower costs at the 400:1 conversion. However, EPO 3 times weekly remained the least costly option by 44–63%. The cost-savings realized with EPO 10000 units 3 times weekly increased with longer duration of hospitalization. Conclusions: In an inpatient setting, use of EPO 10000 units 3 times weekly may minimize expenditures associated with treatment of cancer-related anemia using erythropoietic-stimulating therapies.
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Affiliation(s)
- Aaron D Killian
- Cardinal Health Clinical Research Group, Dallas, TX 75204, USA.
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Boccia RV, Henry DH, Belton L, Bohac C, Ghazal HH. Efficacy and safety of darbepoetin alfa initiated at hemoglobin ≤10 g/dL in patients with stage IV cancer and chemotherapy-induced anemia. Cancer Med 2016; 5:3445-3453. [PMID: 27882724 PMCID: PMC5224845 DOI: 10.1002/cam4.958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 01/26/2023] Open
Abstract
Data on efficacy and safety of darbepoetin alfa (DA) administered at hemoglobin (Hb) ≤10 g/dL are limited. In this analysis, we examined DA's efficacy and safety in patients with Stage IV cancers and chemotherapy‐induced anemia (CIA) initiated on DA at Hb ≤10 g/dL. Data for patients with Stage IV cancers and CIA and who initiated DA at Hb ≤10 g/dL were extracted from three phase 3 trials identified in a central database of Amgen‐sponsored DA studies in CIA. Efficacy outcomes were assessed by achievement of Hb increases of ≥1 g/dL and ≥2 g/dL and red blood cell (RBC) or whole blood transfusion requirements. Data were analyzed for all patients with baseline Hb ≤10 g/dL, and by the subgroups of patients with baseline Hb ≥9 to ≤10 g/dL versus <9 g/dL. Crude and Kaplan–Meier proportions of patients who experienced each outcome and time (days) to each outcome were summarized by treatment. Meta‐analysis (fixed‐effects inverse‐variance model) was performed to compare outcomes for DA versus placebo. Safety was assessed by occurrence of adverse events. Data from 213 patients were analyzed: DA, n = 115; placebo, n = 98. More patients in the DA versus the placebo subgroup achieved Hb increase of ≥1 g/dL (72% vs. 36%; HR: 2.92, 95% CI: 1.95, 4.39) and ≥2 g/dL (44% vs. 18%; HR: 2.98, 95% CI: 1.71, 5.21) during the first 12 treatment weeks. Median times to Hb increase of ≥1 g/dL and ≥2 g/dL were 36 days and 78 days for DA, respectively. RBC or whole blood transfusions were less common in patients in the DA versus the placebo subgroup (24% vs. 45%; HR: 0.44, 95% CI: 0.27, 0.73). No new safety issues were reported. Our results confirm that DA use in patients with Stage IV cancer and CIA is more effective than placebo at increasing Hb levels and at reducing transfusion needs when DA treatment is initiated at Hb ≤10 g/dL.
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Affiliation(s)
- Ralph V Boccia
- Center for Cancer and Blood Disorders, Bethesda, Maryland
| | - David H Henry
- University of Pennsylvania, Philadelphia, Pennsylvania
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Chen L, Jiang H, Gao W, Tu Y, Zhou Y, Li X, Zhu Z, Jiang Q, Zhan H, Yu J, Fu C, Gao Y. Combination with intravenous iron supplementation or doubling erythropoietin dose for patients with chemotherapy-induced anaemia inadequately responsive to initial erythropoietin treatment alone: study protocol for a randomised controlled trial. BMJ Open 2016; 6:e012231. [PMID: 27855097 PMCID: PMC5073518 DOI: 10.1136/bmjopen-2016-012231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Erythropoietin (EPO) is a commonly used option in the treatment of chemotherapy-induced anaemia (CIA). However, ∼30-50% of patients fail to achieve an adequate response after initial treatment. Prior studies have demonstrated that intravenous iron might synergistically improve therapeutic response to EPO treatment in this patient population. METHODS AND ANALYSIS We will perform this multicentre, randomised, open-label, parallel-group, active controlled non-inferiority study to compare the two combination therapies of EPO plus intravenous iron regimen versus doubling the dose of EPO in patients with CIA who have an inadequate response to initial EPO treatment at a routine dose. A total of 603 patients with an increase in haemoglobin (Hb) <1 g/dL will be enrolled and randomised to one of the three study treatment groups at a 1:1:1 ratio Group 1: EPO treatment at the original dose plus intravenous iron dextran 200 mg every 3 weeks (Q3W) for 15 weeks; Group 2: EPO treatment at the original dose plus intravenous iron dextran 100 mg, twice a week for 5 weeks; Group 3: the control group, doubling the EPO dose without preplanned iron supplementation. The primary outcome measure to compare is the Hb response rate at week 15 and the secondary end points involve therapeutic blood transfusions. Time-to-progression, adverse events and quality of life will also be evaluated. ETHICS AND DISSEMINATION All participants will provide informed consent; the study protocol has been approved by the independent ethics committee of Shanghai East Hospital. This study would clearly demonstrate the potential benefit of combining epoetin treatment with intravenous iron supplementation. Findings will be shared with participating hospitals, policymakers and the academic community to promote the clinical management of CIA in China. TRIAL REGISTRATION NUMBER NCT02731378.
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Affiliation(s)
- Lin Chen
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong Jiang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Gao
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ye Tu
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Zhou
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi Li
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhe Zhu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qixin Jiang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haifeng Zhan
- Department of Gynecology, Jing'an District Centre Hospital of Shanghai (Huashan Hospital Fudan University Jing'an Branch), Shanghai, China
| | - Jiangming Yu
- Department of Orthopaedics, Changzheng Hospital, Shanghai, China
| | - Chuangang Fu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong Gao
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Shahid S. Review of hematological indices of cancer patients receiving combined chemotherapy & radiotherapy or receiving radiotherapy alone. Crit Rev Oncol Hematol 2016; 105:145-55. [PMID: 27423975 DOI: 10.1016/j.critrevonc.2016.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/09/2016] [Accepted: 06/01/2016] [Indexed: 01/18/2023] Open
Abstract
We observed the outcomes of chemotherapy with radiotherapy (CR) or radiotherapy (RT) alone for cancer patients of larynx, breast, blood and brain origins through complete blood count (CBC). Following were more depressed in CR patients: mean corpuscular hemoglobin-MCH & lymphocytes-LYM, hematocrit, mean corpuscular hemoglobin concentration-MCHC, hemoglobin-HB and red blood cells-RBC. In RT patients, following were more depressed: LYM, MCH and MCHC. Overall, in all cancer patients, the lymphocytes were depressed 52%. There existed a significant difference between white blood cells and RBC in both CR and RT patients. A significant moderate negative correlation is found in HB with the dose range 30-78 (Gray) given to the CR cancer patients. More number of CBC parameters affected in patients treated with CR and RT; but in less percentage as compared to patients who treated with RT alone. The cancer patients suffered from anemia along with immune modulations from the treatments.
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Affiliation(s)
- Saman Shahid
- Department of Sciences and Humanities, National University of Computer and Emerging Sciences (NUCES)-Foundation for Advancement of Science and Technology (FAST), Lahore, Pakistan.
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Roubinian N, Carson JL. Red Blood Cell Transfusion Strategies in Adult and Pediatric Patients with Malignancy. Hematol Oncol Clin North Am 2016; 30:529-40. [DOI: 10.1016/j.hoc.2016.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Leyland-Jones B, Bondarenko I, Nemsadze G, Smirnov V, Litvin I, Kokhreidze I, Abshilava L, Janjalia M, Li R, Lakshmaiah KC, Samkharadze B, Tarasova O, Mohapatra RK, Sparyk Y, Polenkov S, Vladimirov V, Xiu L, Zhu E, Kimelblatt B, Deprince K, Safonov I, Bowers P, Vercammen E. A Randomized, Open-Label, Multicenter, Phase III Study of Epoetin Alfa Versus Best Standard of Care in Anemic Patients With Metastatic Breast Cancer Receiving Standard Chemotherapy. J Clin Oncol 2016; 34:1197-207. [PMID: 26858335 DOI: 10.1200/jco.2015.63.5649] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE An open-label, noninferiority study to evaluate the impact of epoetin alfa (EPO) on tumor outcomes when used to treat anemia in patients receiving chemotherapy for metastatic breast cancer. METHODS Women with hemoglobin ≤ 11.0 g/dL, receiving first- or second-line chemotherapy for metastatic breast cancer, were randomly assigned to EPO 40,000 IU subcutaneously once a week or best standard of care. The primary end point was progression-free survival (PFS). Secondary end points included overall survival, time to tumor progression, overall response rate, RBC transfusions, and thrombotic vascular events. RESULTS In 2,098 patients randomly assigned, median PFS (based on investigator-determined disease progression [PD]) was 7.4 months in both groups (hazard ratio [HR], 1.089; 95% CI, 0.988 to 1.200); upper bound exceeded prespecified noninferiority margin of 1.15. Median PFS per independent review committee-determined PD was 7.6 months in both groups (HR, 1.028; 95% CI, 0.922 to 1.146); upper bound did not exceed prespecified noninferiority margin. Median overall survival at clinical cutoff (1,337 deaths) was 17.2 months in the EPO and 17.4 months in the best standard of care group (HR, 1.057; 95% CI, 0.949 to 1.177), median time to tumor progression was 7.5 months in both groups (HR, 1.094; 95% CI, 0.991 to 1.209), and overall response rate was 50% versus 51% (odds ratio, 0.950; 95% CI, 0.799 to 1.130). RBC transfusions were 5.8% versus 11.4% (P < .001), and thrombotic vascular events were 2.8% versus 1.4% (P = .038), respectively. CONCLUSION The primary end point, PFS based on investigator-determined PD, did not meet noninferiority criteria. As a consistency assessment with the primary finding, PFS based on independent review committee-determined PD met noninferiority criteria. Overall, this study did not achieve noninferiority objective in ruling out a 15% increased risk in PD/death. RBC transfusion should be the preferred approach for the management of anemia in this population.
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Affiliation(s)
- Brian Leyland-Jones
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ.
| | - Igor Bondarenko
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Gia Nemsadze
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Vitaliy Smirnov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Iryna Litvin
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Irakli Kokhreidze
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Lia Abshilava
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Mikheil Janjalia
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Rubi Li
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Kuntegowda C Lakshmaiah
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Beka Samkharadze
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Oksana Tarasova
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Ranjan Kumar Mohapatra
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Yaroslav Sparyk
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Sergey Polenkov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Vladimir Vladimirov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Liang Xiu
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Eugene Zhu
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Bruce Kimelblatt
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Kris Deprince
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Ilya Safonov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Peter Bowers
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Els Vercammen
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
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Ludwig H, Evstatiev R, Kornek G, Aapro M, Bauernhofer T, Buxhofer-Ausch V, Fridrik M, Geissler D, Geissler K, Gisslinger H, Koller E, Kopetzky G, Lang A, Rumpold H, Steurer M, Kamali H, Link H. Iron metabolism and iron supplementation in cancer patients. Wien Klin Wochenschr 2015; 127:907-19. [PMID: 26373748 PMCID: PMC4679104 DOI: 10.1007/s00508-015-0842-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/29/2015] [Indexed: 12/21/2022]
Abstract
Iron deficiency and iron deficiency-associated anemia are common complications in cancer patients. Most iron deficient cancer patients present with functional iron deficiency (FID), a status with adequate storage iron, but insufficient iron supply for erythroblasts and other iron dependent tissues. FID is the consequence of the cancer-associated cytokine release, while in absolute iron deficiency iron stores are depleted resulting in similar but often more severe symptoms of insufficient iron supply. Here we present a short review on the epidemiology, pathophysiology, diagnosis, clinical symptoms, and treatment of iron deficiency in cancer patients. Special emphasis is given to intravenous iron supplementation and on the benefits and limitations of different formulations. Based on these considerations and recommendations from current international guidelines we developed recommendations for clinical practice and classified the level of evidence and grade of recommendation according to the principles of evidence-based medicine.
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Affiliation(s)
- Heinz Ludwig
- c/o 1. Medizinische Abteilung, Zentrum für Onkologie, Wilhelminen-Krebsforschungsinstitut, Wilhelminenspital, Montleartstraße 37, 1160, Wien, Austria.
| | - Rayko Evstatiev
- Universitätsklinik für Innere Medizin III, MedUni, Wien, Austria
| | - Gabriela Kornek
- Universitätsklinik für Innere Medizin I, MedUni, Wien, Austria
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie IMO, Clinique de Genolier, Genolier, Switzerland
| | | | | | | | - Dietmar Geissler
- 1. Medizinische Abteilung, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Klaus Geissler
- 5. Medizinische Abteilung, Krankenhaus Hietzing, Wien, Austria
| | | | | | - Gerhard Kopetzky
- 1. Medizinische Abteilung, Landesklinikum St. Pölten, Pölten, Austria
| | - Alois Lang
- Abteilung für Innere Medizin, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Holger Rumpold
- Abteilung für Interne 1, Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | - Michael Steurer
- Universitätsklinik für Innere Medizin V, MedUni Innsbruck, Innsbruck, Austria
| | | | - Hartmut Link
- Medizinische Klinik I, Westpfalz-Klinikum, Kaiserslautern, Germany
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29
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Steensma DP, Dakhil SR, Novotny PJ, Sloan JA, Johnson DB, Anderson DM, Mattar BI, Moore DF, Nikcevich D, Loprinzi CL. A randomized comparison of once weekly epoetin alfa to extended schedule epoetin or darbepoetin in chemotherapy-associated anemia. Am J Hematol 2015; 90:877-81. [PMID: 26149465 DOI: 10.1002/ajh.24110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 06/29/2015] [Accepted: 07/02/2015] [Indexed: 11/08/2022]
Abstract
Erythropoiesis-stimulating agents (ESAs) epoetin alfa (EA) and darbepoetin alfa (DA) increase hemoglobin (Hb) levels and reduce red blood cell (RBC) transfusion requirements in patients with cancer chemotherapy-associated anemia (CAA). Extended-interval ESA dosing (administration less than once weekly) is common with DA, but previous studies suggested that EA might also be administered less often than weekly. In this multicenter prospective trial, 239 CAA patients with Hb <10.5 g/dL were randomized to receive EA 40,000 U subcutaneously once weekly ("40K" arm), EA 80,000 U every 3 weeks ("80K"), EA 120,000 U every 3 weeks ("120K" arm), or DA 500 mcg every 3 weeks ("DA"), for 15 weeks. The primary endpoint was the proportion of patients achieving Hb ≥ 11.5 g/dL or increment of Hb > 2.0 g/dL from baseline without transfusion. Secondary endpoints included transfusion requirements, adverse events (AEs), and patient-reported outcomes (PROs). There were no significant differences between treatment arms in the proportion of patients achieving Hb response (68.9% for 40K, 61.7% for 80K, 65.5% for 120K, and 66.7% for DA; P > 0.41 for all comparisons) or requiring RBC transfusion, but the median Hb increment from baseline was higher in the 40K and DA arms compared to the two extended dosing EA arms, and Hb response was achieved soonest in the weekly EA arm. There were no differences in PROs or AEs. The FDA-approved schedules tested-weekly EA 40,000 U, and every 3 week DA 500 mcg-are reasonable standards for CAA therapy.
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Affiliation(s)
- David P. Steensma
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
| | | | | | - Jeff A. Sloan
- Cancer Center Statistics, Mayo Clinic; Rochester Minnesota
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The effects of erythropoiesis-stimulating agents on the short-term and long-term survivals in metastatic breast cancer patients receiving chemotherapy: a SEER population-based study. Breast Cancer Res Treat 2015; 153:407-16. [PMID: 26264468 DOI: 10.1007/s10549-015-3532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
Current clinical guidelines state that the use of erythropoiesis-stimulating agents (ESAs) may be considered to treat chemotherapy-induced anemia in the non-curative setting to alleviate anemia-related symptoms. However, no convincing survival benefit has been demonstrated to support the use of ESAs in these patients. Using the comprehensive data collected in the National Cancer Institute (NCI)-surveillance epidemiology and end results (SEER) and Medicare-linked database, we analyzed the effect of ESA use on the short-term (18-month) and long-term (60-month) survival rates of chemotherapy-treated metastatic breast cancer patients. Confounding variables were adjusted using a propensity score approach. We also analyzed the effects of ESA on the survival of patients receiving trastuzumab, a commonly prescribed targeted therapy agent in treating HER2-positive tumors. Metastatic breast cancer patients who received ESA treatment exhibited similar 60-month survival rate to those without ESA treatment (22.8 vs. 24.9%, p = 0.8). ESA-treated patients had a trend toward better 18-month survival [crude hazard ratio (HR) 0.86, 95% confidence intervals (CI) 0.68-1.09, p = 0.21]. This protective effect during the first 18 months of chemotherapy became marginally significant after adjusting for the propensity of receiving ESAs (HR 0.80, 95% CI 0.63-1.01, p = 0.070). An interaction effect between ESA and trastuzumab on patient survival was noticeable but not statistically significant. ESAs did not negatively affect the long-term survival of metastatic breast cancer patients. Moreover, ESAs improved patients' survival during the first 18 months of chemotherapy treatment. These findings endorse the current clinical guideline. Given the short survival of these patients, the potential short-term beneficial effects of ESAs are clinically meaningful.
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31
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Galli L, Ricci C, Egan CG. Epoetin beta for the treatment of chemotherapy-induced anemia: an update. Onco Targets Ther 2015; 8:583-91. [PMID: 25784818 PMCID: PMC4356683 DOI: 10.2147/ott.s77497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Epoetin beta belongs to the class of erythropoiesis-stimulating agents (ESAs) that are currently available to treat anemic patients receiving chemotherapy. Chemotherapy-induced anemia affects a high percentage of cancer patients and, due to its negative effects on disease outcome and the patient’s quality of life, should be treated when first diagnosed. Initial trials with ESAs have shown efficacy in improving quality of life and reducing the need for blood transfusions in patients with chemotherapy-induced anemia. However, recent meta-analyses have provided conflicting data on the impact of ESAs on survival and tumor progression. Here we provide an overview of these recent data and review the role of epoetin beta in the treatment of chemotherapy-induced anemia over the past 20 years.
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Affiliation(s)
- Luca Galli
- Oncology Unit 2, University Hospital of Pisa, Pisa, Italy
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32
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Waldman L, Morrison LJ. Sleep disorders and fatigue: special issues in the older adult with cancer. Cancer J 2014; 20:352-7. [PMID: 25299145 DOI: 10.1097/ppo.0000000000000072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Older adults with cancer reporting fatigue and sleep disorders often have coexisting geriatric syndromes and are at high risk of further functional decline. This review summarizes special considerations in the diagnosis and treatment of sleep disorders and fatigue when older persons with cancer present with multiple comorbidities, polypharmacy, dementia, delirium, and/or falls. Physicians caring for these older adults need to be aware of the unique diagnostic and treatment concerns in this population so that these patients can receive optimal care.
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Affiliation(s)
- Louis Waldman
- From the Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT
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33
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Ludwig H, Aapro M, Bokemeyer C, Glaspy J, Hedenus M, Littlewood T, Österborg A, Rzychon B, Mitchell D, Beguin Y. A European patient record study on diagnosis and treatment of chemotherapy-induced anaemia. Support Care Cancer 2014; 22:2197-206. [PMID: 24659244 PMCID: PMC4082648 DOI: 10.1007/s00520-014-2189-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/02/2014] [Indexed: 01/28/2023]
Abstract
Purpose Patients with cancer frequently experience chemotherapy-induced anaemia (CIA) and iron deficiency. Erythropoiesis-stimulating agents (ESAs), iron supplementation and blood transfusions are available therapies. This study evaluated routine practice in CIA management. Methods Medical oncologists and/or haematologists from nine European countries (n = 375) were surveyed on their last five cancer patients treated for CIA (n = 1,730). Information was collected on tests performed at diagnosis of anaemia, levels of haemoglobin (Hb), serum ferritin and transferrin saturation (TSAT), as well as applied anaemia therapies. Results Diagnostic tests and therapies for CIA varied across Europe. Anaemia and iron status were mainly assessed by Hb (94 %) and ferritin (48 %) measurements. TSAT was only tested in 14 %. At anaemia diagnosis, 74 % of patients had Hb ≤10 g/dL, including 15 % with severe anaemia (Hb <8 g/dL). Low-iron levels (ferritin ≤100 ng/mL) were detected in 42 % of evaluated patients. ESA was used in 63 % of patients, blood transfusions in 52 % and iron supplementation in 31 % (74 % oral, 26 % intravenous iron). Only 30 % of ESA-treated patients received a combination of ESA and iron supplementation. Blood transfusions formed part of a regular anaemia treatment regimen in 76 % of transfused patients. Management practices were similar in 2009 and 2011. Conclusion Management of anaemia and iron status in patients treated for CIA varies substantially across Europe. Iron status is only assessed in half of the patients. In contrast to clinical evidence, iron treatment is underutilised and mainly based on oral iron supplementation. Implementation of guidelines needs to be increased to minimize the use of blood transfusions.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - M. Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
| | | | - J. Glaspy
- UCLA School of Medicine, Los Angeles, USA
| | | | | | - A. Österborg
- Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | | | - Y. Beguin
- CHU of Liège and University of Liège, Liège, Belgium
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Debus J, Drings P, Baurecht W, Angermund R. Prospective, randomized, controlled, and open study in primarily inoperable, stage III non-small cell lung cancer (NSCLC) patients given sequential radiochemotherapy with or without epoetin alfa. Radiother Oncol 2014; 112:23-9. [PMID: 25129551 DOI: 10.1016/j.radonc.2014.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Induction chemotherapy is associated with anemia in non-small cell lung cancer (NSCLC) patients undergoing radiotherapy. This randomized, open-label study compared the effect of sequential radiochemotherapy (RCHT) versus RCHT + epoetin alfa (RCHT + EPO), with respect to 2-year overall survival (OS). MATERIAL AND METHODS Patients ⩾18 years received sequential RCHT; one arm also received EPO (chemotherapy day 1, when Hb<12 g/dL). Kaplan-Meier analysis with log-rank test, and Cox-regression methods were performed. RESULTS Of the 385 patients randomized (RCHT + EPO: n = 195; RCHT: n = 190), 78 (RCTH + EPO: 46 [23.6%]; RCHT: 32 [16.8%]) were anemic at baseline. Two-year OS was higher in RCHT + EPO-treated versus RCHT-treated (28.5% [95% CI: 22.2-35.1%] versus 20.6% [95% CI: 15.1-26.8%] [p = 0.2278]), and requirement for RBC transfusion was lower (24/195 [12.3%] versus 61/190 [32.1%]). In anemic (baseline) patients (post hoc analysis), median survival was shorter in RCTH-treated (212 days) versus RCHT + EPO-treated (343 days) (Hazard ratio = 1.62 [95% CI: 0.99-2.63], p = 0.0525). Adverse events were documented in 72.7% (RCHT + EPO: 75.0%; RCHT: 70.5%) patients, and thrombovascular events (TVEs) in 45 patients (RCHT + EPO: 16.7%; RCHT: 7.9%; p = 0.0099). CONCLUSIONS A statistically non-significant trend for 2-year OS was observed in a sub-group of EPO-treated NSCLC-patients with baseline anemia, although this trend was not maintained in the overall population with inoperable NSCLC.
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35
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Nitz U, Gluz O, Zuna I, Oberhoff C, Reimer T, Schumacher C, Hackmann J, Warm M, Uleer C, Runde V, Dünnebacke J, Belzl N, Augustin D, Kates RE, Harbeck N. Final results from the prospective phase III WSG-ARA trial: impact of adjuvant darbepoetin alfa on event-free survival in early breast cancer. Ann Oncol 2014; 25:75-80. [PMID: 24356620 DOI: 10.1093/annonc/mdt505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND WSG-ARA plus trial evaluated the effect of adjuvant darbepoetin alfa (DA) on outcome in node positive primary breast cancer (BC). PATIENTS AND METHODS One thousand two hundred thirty-four patients were randomized to chemotherapy either with DA (DA+; n = 615) or without DA (DA-; n = 619). DA (500 µg q3w) was started at hemoglobin (Hb) levels <13.0 g/dl (<12 g/dl after DA label amendment) and stopped at Hb levels ≥14.0 g/dl (12 g/dl after label amendment). Primary efficacy end point was event-free survival (EFS); secondary end points were toxicity, quality of life (QoL) and overall survival (OS). RESULTS Venous thrombosis (DA+: 3.0%, DA-: 1.0%; P = 0.013) was significantly higher for DA+, but not pulmonary embolism (0.3% in both arms). Median Hb levels were stable in DA+ (12.6 g/dl) and decreased in DA- (11.7 g/dl). Hb levels >15 g/dl were reported in 0.8% of cycles. QoL parameters did not significantly differ between arms. At 39 months, DA had no significant impact on EFS (DA+: 89.3%, DA-: 87.5%; Plog-rank = 0.55) or OS (DA+: 95.5%, DA-: 95.4%; Plog-rank = 0.77). CONCLUSIONS DA treatment did not impact EFS or OS in routine adjuvant BC treatment.
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Affiliation(s)
- U Nitz
- Breast Center Niederrhein, Evangelic Hospital Bethesda, Moenchengladbach
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36
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Bohlius J, Tonia T, Nüesch E, Jüni P, Fey MF, Egger M, Bernhard J. Effects of erythropoiesis-stimulating agents on fatigue- and anaemia-related symptoms in cancer patients: systematic review and meta-analyses of published and unpublished data. Br J Cancer 2014; 111:33-45. [PMID: 24743705 PMCID: PMC4090721 DOI: 10.1038/bjc.2014.171] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) reduce the need for red blood cell transfusions; however, they increase the risk of thromboembolic events and mortality. The impact of ESAs on quality of life (QoL) is controversial and led to different recommendations of medical societies and authorities in the USA and Europe. We aimed to critically evaluate and quantify the effects of ESAs on QoL in cancer patients. METHODS We included data from randomised controlled trials (RCTs) on the effects of ESAs on QoL in cancer patients. Randomised controlled trials were identified by searching electronic data bases and other sources up to January 2011. To reduce publication and outcome reporting biases, we included unreported results from clinical study reports. We conducted meta-analyses on fatigue- and anaemia-related symptoms measured with the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and FACT-Anaemia (FACT-An) subscales (primary outcomes) or other validated instruments. RESULTS We identified 58 eligible RCTs. Clinical study reports were available for 27% (4 out of 15) of the investigator-initiated trials and 95% (41 out of 43) of the industry-initiated trials. We excluded 21 RTCs as we could not use their QoL data for meta-analyses, either because of incomplete reporting (17 RCTs) or because of premature closure of the trial (4 RCTs). We included 37 RCTs with 10581 patients; 21 RCTs were placebo controlled. Chemotherapy was given in 27 of the 37 RCTs. The median baseline haemoglobin (Hb) level was 10.1 g dl(-1); in 8 studies ESAs were stopped at Hb levels below 13 g dl(-1) and in 27 above 13 g dl(-1). For FACT-F, the mean difference (MD) was 2.41 (95% confidence interval (95% CI) 1.39-3.43; P<0.0001; 23 studies, n=6108) in all cancer patients and 2.81 (95% CI 1.73-3.90; P<0.0001; 19 RCTs, n=4697) in patients receiving chemotherapy, which was below the threshold (≥ 3) for a clinically important difference (CID). Erythropoiesis-stimulating agents had a positive effect on anaemia-related symptoms (MD 4.09; 95% CI 2.37-5.80; P=0.001; 14 studies, n=2765) in all cancer patients and 4.50 (95% CI 2.55-6.45; P<0.0001; 11 RCTs, n=2436) in patients receiving chemotherapy, which was above the threshold (≥ 4) for a CID. Of note, this effect persisted when we restricted the analysis to placebo-controlled RCTs in patients receiving chemotherapy. There was some evidence that the MDs for FACT-F were above the threshold for a CID in RCTs including cancer patients receiving chemotherapy with Hb levels below 12 g dl(-1) at baseline and in RCTs stopping ESAs at Hb levels above 13 g dl(-1). However, these findings for FACT-F were not confirmed when we restricted the analysis to placebo-controlled RCTs in patients receiving chemotherapy. CONCLUSIONS In cancer patients, particularly those receiving chemotherapy, we found that ESAs provide a small but clinically important improvement in anaemia-related symptoms (FACT-An). For fatigue-related symptoms (FACT-F), the overall effect did not reach the threshold for a CID.
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Affiliation(s)
- J Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - T Tonia
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - E Nüesch
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - P Jüni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
- Department of Clinical Research, CTU Bern, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - M F Fey
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - M Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - J Bernhard
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
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Erythropoietin therapy after allogeneic hematopoietic cell transplantation: a prospective, randomized trial. Blood 2014; 124:33-41. [DOI: 10.1182/blood-2014-01-546333] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Key Points
Erythropoietin therapy can be effective to hasten erythroid recovery and reduce transfusion requirements after allogeneic HCT.
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Dose Efficiency of Erythropoiesis-Stimulating Agents for the Treatment of Patients With Chemotherapy-Induced Anemia: A Systematic Review. Clin Ther 2014; 36:594-610. [DOI: 10.1016/j.clinthera.2014.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 01/29/2014] [Accepted: 02/07/2014] [Indexed: 11/20/2022]
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39
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Erythropoietin-stimulating agents and clinical outcomes in metastatic breast cancer patients with chemotherapy-induced anemia: a closed debate? Tumour Biol 2014; 35:5095-100. [DOI: 10.1007/s13277-014-1730-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022] Open
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40
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Lapierre A, Souquet PJ. Utilisation des facteurs de croissance érythrocytaires. Rev Mal Respir 2014; 31:162-72. [DOI: 10.1016/j.rmr.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/03/2013] [Indexed: 12/15/2022]
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41
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Littlewood TJ, Collins GP. Pharmacotherapy of anemia in cancer patients. Expert Rev Clin Pharmacol 2014; 1:307-17. [DOI: 10.1586/17512433.1.2.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Littlewood T, Collins G. Epoetin alfa: basic biology and clinical utility in cancer patients. Expert Rev Anticancer Ther 2014; 5:947-56. [PMID: 16336085 DOI: 10.1586/14737140.5.6.947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anemia in cancer patients undergoing treatment is common and can cause debilitating symptoms such as fatigue and reduced exercise tolerance. The introduction of recombinant human erythropoietin represents a potential improvement in the treatment of this condition. Clinical studies in patients with solid tumors and nonmyeloid hematologic malignancies have convincingly shown an improvement in mean hemoglobin concentration, a reduction in transfusion requirement along with an improvement in quality of life scores, although an effect on survival is less clear. In myeloid disorders such as myelodysplasia, response to single-agent recombinant human erythropoietin is disappointing but significant synergism with granulocyte colony stimulating factor has been demonstrated and different dosing regimens may also improve response. Unfortunately, a significant proportion of patients remain refractory to treatment. Efforts have been made to identify treatable causes of erythropoietin refractoriness, such as functional iron deficiency, and concomitant intravenous iron supplementation does appear to improve response rates. The search for pretreatment factors that predict response has been largely disappointing, although a promising model for myelodysplasia has been developed that awaits large-scale evaluation. Recombinant human erythropoietin is well tolerated, although there were concerns in the late 1990s due to a rising incidence of pure red cell aplasia in chronic renal failure patients treated with subcutaneous Eprex (Ortho Biologics) in Europe. Since potentially contributory manufacturing processes have been identified and corrected, the incidence of this complication has been falling.
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Affiliation(s)
- Timothy Littlewood
- Department of Haematology, Level 4, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
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Duh MS, Latypova A, Greenberg P. Impact and treatment of anemia in the elderly: clinical, epidemiological and economic perspectives. Expert Rev Pharmacoecon Outcomes Res 2014; 6:577-90. [DOI: 10.1586/14737167.6.5.577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhou B, Damrauer JS, Bailey ST, Hadzic T, Jeong Y, Clark K, Fan C, Murphy L, Lee CY, Troester MA, Miller CR, Jin J, Darr D, Perou CM, Levine RL, Diehn M, Kim WY. Erythropoietin promotes breast tumorigenesis through tumor-initiating cell self-renewal. J Clin Invest 2014; 124:553-63. [PMID: 24435044 DOI: 10.1172/jci69804] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/24/2013] [Indexed: 12/30/2022] Open
Abstract
Erythropoietin (EPO) is a hormone that induces red blood cell production. In its recombinant form, EPO is the one of most prescribed drugs to treat anemia, including that arising in cancer patients. In randomized trials, EPO administration to cancer patients has been associated with decreased survival. Here, we investigated the impact of EPO modulation on tumorigenesis. Using genetically engineered mouse models of breast cancer, we found that EPO promoted tumorigenesis by activating JAK/STAT signaling in breast tumor-initiating cells (TICs) and promoted TIC self renewal. We determined that EPO was induced by hypoxia in breast cancer cell lines, but not in human mammary epithelial cells. Additionally, we demonstrated that high levels of endogenous EPO gene expression correlated with shortened relapse-free survival and that pharmacologic JAK2 inhibition was synergistic with chemotherapy for tumor growth inhibition in vivo. These data define an active role for endogenous EPO in breast cancer progression and breast TIC self-renewal and reveal a potential application of EPO pathway inhibition in breast cancer therapy.
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Abstract
Anemia complicates the course of disease in about 50% of patients with cancer, and negatively affects their quality of life. A correct approach to therapy should consider all the possible causes and patients need to be treated accordingly. The observation that erythropoietin production is often blunted offers new treatment possibilities. Fifty to 70% of anemic patients respond to rHuEpo, given in a three times or once-a-week schedule. The novel hyperglycosylated protein darbepoetin permits longer intervals between administrations, thanks to its longer half-life, and a once per cycle or once-a-month schedule is a reasonable target. Correction of anemia improves the quality of life, and it has been hypothesized that improvement of cognitive function may derive from a direct effect of Epo on CNS cells. Although anemia is an adverse prognostic factor in cancer, results of recent clinical trials have raised the question whether rHuEpo may favor neoplastic cell proliferation. Results are conflicting at the moment, and further studies are required before arriving at a conclusion. Data available so far do not indicate any negative effect of darbepoetin on the outcome of cancer disease, nor has the production of anti-darbepoetin antibodies or PRCA been reported, a complication observed in less than 200 patients with anemia due to renal insufficiency and treated with rHuEpo alpha.
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Affiliation(s)
- A Grossi
- Postgraduation School of Hematology, University of Florence, Florence, Italy.
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Cömert M, Güneş AE, Sahin F, Saydam G. Quality of life and supportive care in multiple myeloma. Turk J Haematol 2013; 30:234-46. [PMID: 24385802 PMCID: PMC3878535 DOI: 10.4274/tjh.2012.0192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/01/2013] [Indexed: 12/01/2022] Open
Abstract
Multiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient’s quality of life and also can improve survival. The aim of this review is to highlight the relationship among life of quality, supportive care, and improvement in survival. Conflict of interest:None declared.
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Affiliation(s)
- Melda Cömert
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Ajda Ersoy Güneş
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Fahri Sahin
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Güray Saydam
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
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Abdelrazik N, Fouda M. Once weekly recombinant human erythropoietin treatment for cancer-induced anemia in children with acute lymphoblastic leukemia receiving maintenance chemotherapy: A randomized case-controlled study. Hematology 2013; 12:533-41. [PMID: 17852440 DOI: 10.1080/10245330701521572] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Patients receiving chemotherapy for cancer often develop anemia, which can contribute to increased morbidity and reduced quality of life (QOL). Chemotherapy-induced anemia can be successfully treated using recombinant human erythropoietin (rHuEPO). AIM OF THE STUDY To demonstrate the effectiveness of once-weekly (QW) rHuEPO dosing to effect improved hemoglobin levels, decreased transfusion use, and improved functional outcomes and QOL in pediatric leukemic patients (ALL) receiving maintenance chemotherapy. PATIENT AND METHODS This was a prospective randomized, single-center, open-label, 12-week case-control study of epoetin alfa in pediatric patients with acute lymphoblastic leukemia (ALL) in remission receiving maintenance chemotherapy. Sixty patients were randomly assigned to receive either epoetin alfa (rHuEPO group = 30 cases, 17 males and 13 females, age; 6.8 +/- 2.33 years), or no epoetin alfa (control group = 30 cases, 16 males and 14 females, age; 6.76 +/- 2.28 years). Both groups were matched as regard age, sex, baseline Hb concentration, remission state, chemotherapy regimen, numbers and amount of blood transfusion, and leukemia state (both were low and standard risk). Epoetin alfa was administered at a dose of 450 IU/kg, once weekly, subcutaneously (s.c.) for 12 consecutive weeks. Endpoints were changes in hematologic and QOL parameters. RESULTS Among the 30 patients evaluable for hematologic response, the mean increase in Hb from baseline to time of final evaluation was 3.08 +/- 1.48 g/dl (p < 0.001). An increase in Hb of > or = 2 g/dl, in the absence of blood transfusion, occurred in 70% of patients (21 of 30 patients) who were on the study for > or = 30 days. The overall response rate (Hb increase > or = 2 g/dl or Hb > or = 12 g/dl in the absence of blood transfusion) was 90% (27 of 30 patients). In 30 patients who were evaluable for QOL assessment, epoetin-alpha therapy was found to significantly (p < 0.001) improve mean cancer linear analog scale (CLAS) scores for energy level, ability to perform daily activity, and overall QOL from baseline to the time of final evaluation. QW epoetin-alpha was found to be well tolerated. CONCLUSION Treatment with QW epoetin-alpha was found to increase Hb levels, decrease transfusion requirement, and improve functional status and QOL in anemic patients with ALL in maintenance receiving chemotherapy. The once-weekly schedule is convenient, safe, and may reduce the burden on patients, parents, and their caregivers by reducing the number of visits to the clinic.
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Affiliation(s)
- Nabil Abdelrazik
- Pediatric Hematology, Oncology, and BMT unit, Department of Pediatrics, Mansoura University Children Hospital (MUCH), Mansoura, Egypt.
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Abdel-Razeq H, Abbasi S, Saadi I, Jaber R, Abdelelah H. Intravenous iron monotherapy for the treatment of non-iron-deficiency anemia in cancer patients undergoing chemotherapy: a pilot study. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:939-44. [PMID: 24039403 PMCID: PMC3770628 DOI: 10.2147/dddt.s45674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Anemia in patients with cancer who are undergoing active therapy is commonly encountered and may worsen quality of life in these patients. The effect of blood transfusion is often temporary and may be associated with serious adverse events. Erythropoiesis-stimulating agents are not effective in 30%–50% of patients and may have a negative effect on overall survival. Aims To assess the efficacy and feasibility of intravenous iron therapy in patients with cancer who have non-iron-deficiency anemia and who are undergoing treatment with chemotherapy without the use of erythropoiesis-stimulating agents. Methods Adult patients with solid cancers and non-iron-deficiency anemia were included. Ferric sucrose at a dose of 200 mg was given in short intravenous infusions weekly for a total of 12 weeks. Hemoglobin level was measured at baseline, every 3 weeks, and 2 weeks after the last iron infusion (week 14). Adverse events related to intravenous iron were prospectively reported. Results Of 25 patients included, 19 (76.0%) completed at least three iron infusions and 14 (56.0%) finished the planned 12 weeks of therapy. The mean hemoglobin level of the 25 patients at baseline was 9.6 g/dL (median, 9.9 g/dL; range, 6.9 g/dL 10.9 g/dL). The mean change in hemoglobin level for the 15 patients who completed at least 9 treatments was 1.7 g/dL (median, 1.1 g/dL; range, −1.9 g/dL to 3.2 g/dL); it reached 2.1 g/dL (median, 1.3 g/dL; range, −0.2 g/dL to 4.6 g/dL; P = 0.0007) for the 14 patients who completed all 12 weekly treatments. Five (20.0%) patients were transfused and considered as treatment failures. No treatment-related adverse events were reported. Conclusion Intravenous iron treatment alone is safe and may reduce blood transfusion requirements and improve hemoglobin level in patients with cancer who are undergoing anticancer therapy. Further randomized studies are needed to confirm these findings.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
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Moebus V, Jackisch C, Schneeweiss A, Huober J, Lueck HJ, du Bois A, Thomssen C, Kurbacher C, Kuhn W, Nitz U, Runnebaum IB, Hinke A, Kreienberg R, Untch M. Adding epoetin alfa to intense dose-dense adjuvant chemotherapy for breast cancer: randomized clinical trial. J Natl Cancer Inst 2013; 105:1018-26. [PMID: 23860204 PMCID: PMC3714019 DOI: 10.1093/jnci/djt145] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background The AGO-ETC trial compared 5-year relapse-free survival of intense dose-dense (IDD) sequential chemotherapy with epirubicin (E), paclitaxel (T), and cyclophosphamide (C) (IDD-ETC) every 2 weeks vs conventional scheduled epirubicin/cyclophosphamide followed by paclitaxel (EC→T) (every 3 weeks) as adjuvant treatment in high-risk breast cancer patients. The objective of this study was to evaluate the safety and efficacy of epoetin alfa in a second randomization of the intense dose-dense arm. Methods One thousand two hundred eighty-four patients were enrolled; 658 patients were randomly assigned to the IDD-ETC treatment group. Within the IDD-ETC group, 324 patients were further randomly assigned to the epoetin alfa group, and 319 were randomly assigned to the non–erythropoiesis-stimulating agent (ESA) control group. Primary efficacy endpoints included change in hemoglobin level from baseline to Cycle 9 and the percentage of subjects requiring red blood cell transfusion. Relapse-free survival, overall survival, and intramammary relapse were secondary endpoints estimated with Kaplan-Meier and Cox regression methods. Except for the primary hypothesis, all statistical tests were two-sided. Results Epoetin alfa avoided the decrease in hemoglobin level (no decrease in the epoetin alfa group vs –2.20g/dL change for the control group; P < .001) and statistically significantly reduced the percentage of subjects requiring red blood cell transfusion (12.8% vs 28.1%; P < .0001). The incidence of thrombotic events was 7% in the epoetin alfa arm vs 3% in the control arm. After a median follow-up of 62 months, epoetin alfa treatment did not affect overall survival, relapse-free survival, or intramammary relapse. Conclusions Epoetin alfa resulted in improved hemoglobin levels and decreased transfusions without an impact on relapse-free or overall survival. However, epoetin alfa had an adverse effect, resulting in increased thrombosis.
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Affiliation(s)
- Volker Moebus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Frankfurt, Germany.
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Gascón P, Rodríguez CA, Valentín V, Mata JG, Carulla J, Cassinello J, Colomer R, Baró E. Usefulness of the PERFORM questionnaire to measure fatigue in cancer patients with anemia: a prospective, observational study. Support Care Cancer 2013; 21:3039-49. [PMID: 23793142 PMCID: PMC3789890 DOI: 10.1007/s00520-013-1862-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/21/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The PERFORM Questionnaire is a 12-item scale developed for assessing fatigue in cancer patients in the clinical practice. It has advantages over other tools in that it is short and includes beliefs and attitudes of patients about fatigue. It was psychometrically validated in cancer patients with and without anemia. PURPOSE We evaluated the usefulness of the PERFORM scale to measure fatigue in a large study focusing exclusively on anemic patients. METHODS This was an observational, multicenter, prospective, 3-month study in cancer patients with hemoglobin (Hb)≤11 g/dl. Fatigue was assessed using the PERFORM questionnaire. The overall score ranges from 12 (no fatigue) to 60 (maximum fatigue). RESULTS We included 667 patients: 54.1 % women, mean age 60 (standard deviation, 12) years. A highly significant, but mild correlation was observed between low baseline Hb and high patient perception of fatigue (r with PERFORM score=-0.215, p < 0.0001). Of the patients, 65.8 % improved Hb level during follow-up (increase of ≥1 g/dL and/or achieving >11 g/dL), which translated into a significant improvement in the PERFORM score [mean (95 % confidence interval (CI)] change, -1.2 (-0.04 to -2.4), whereas more fatigue was observed in patients without improvement in Hb [change (95 % CI) in PERFORM, +3.3 (1.5 to 5)]. In a multivariate linear regression analysis, the independent factors associated to fatigue at 3 months were a low Hb level, a low Karnofsky index, active chemotherapy, cancer treatment with palliative intention, and transfusion need in the last 3 months. CONCLUSIONS Minimal increases or decreases in Hb of ≥1 g/dL were associated with meaningful changes in patient-perceived fatigue as measured with the PERFORM questionnaire. In addition to anemia severity, other factors such as active chemotherapy and advanced disease contribute to perception of fatigue by cancer patients.
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Affiliation(s)
- Pere Gascón
- Hospital Clínic de Barcelona, Villarroel 170, ES-08036, Barcelona, Spain,
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