Anemia management with erythropoietic stimulating therapies (ESTs) in patients (pts) with gastrointestinal (GI) malignancies: Results from a prospective observational study

19614

Background: Chemotherapy-induced anemia is a common problem for pts with GI malignancies. To assess dosing patterns and outcomes in GI malignancy pts treated with ESTs (epoetin alfa (EPO) and darbepoetin alfa (DARB), a subset analysis of an ongoing registry was conducted. Methods: Data drawn between1/04 and 10/06 from 41 U.S. oncology clinics from the Dosing and Outcomes Study of Erythropoietic Stimulating Therapies (D.O.S.E.) registry were assessed. Pts were included in this analysis if they were diagnosed with a GI malignancy (colon, rectal, gastric, esophageal, or pancreatic), = 18 years, and received = 2 doses of either EPO or DARB. Outcomes assessed included mean baseline (BL) characteristics, transfusion utilization, hemoglobin (Hb) at Weeks 4, 8, and 12 after initiation of EPO or DARB, and cumulative EST doses with associated cost (based on 9/2006 wholesale acquisition cost). Results: 186 pts (82 EPO, 104 DARB) were identified. BL characteristics were similar between treatment groups: age 64 years, 45% women, and Hb 10.5g/dL. Both groups had a similar treatment duration (7 weeks) and number of Hb determinations (7.6); however, the DARB group had significantly more office visits (EPO 7, DARB 9.8, p=.0006). The proportion of pts transfused from Week 5 to end of study and number of units transfused/pt were similar between both groups. Hb values were similar at Weeks 4 (11.1 g/dL), 8 (11.1 g/dL), and 12 (11.0 g/dL). The mean administered dose per injection was 42,143 Units for EPO and 225 mcg for DARB. Mean cumulative administered dose during the treatment episode was 296,476 Units for EPO and 1,131 mcg for DARB, resulting in a dose ratio of 262:1 (Units EPO:mcg DARB). Overall EST cost was significantly lower in the EPO group compared to the DARB group (EPO $3,608, DARB $5,028, p=.0024). Conclusions: Similar hematological outcomes for EPO- and DARB-treated pts with GI malignancies were observed. Based on observed dosing patterns and cumulative EST utilization from this prospective observational study, EST costs were 28% lower in the EPO group than the DARB group. The observed dose ratio is consistent with previously reported clinical studies.

No significant financial relationships to disclose.

Hematologic outcomes of epoetin-alpha-treated cancer patients based on initial intervention of Hb <10 compared to Hb 10–11 g/dL: Results from a prospective observational study

19542

Background: Current guidelines recommend consideration of epoetin alfa (EPO) therapy for chemotherapy-induced anemia (CIA) when Hb <11 g/dL (National Comprehensive Cancer Network) or Hb < 10g/dL (ASCO/ASH). To evaluate clinical outcomes in EPO-treated patients initiated at Hb < 10 v. 10–11 g/dL, an analysis was conducted of clinical outcomes from practice settings. Data were analyzed from the Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (D.O.S.E.) Registry, an ongoing, prospective registry collecting data on real-world practice patterns. Methods: Data from 29 U.S. hospital and community-based outpatient practices were assessed from 1/04–10/06. Chemotherapy-treated adult patients with a non-myeloid malignancy, baseline anemia (Hb < 11 g/dL), receipt of at least two EPO doses, and study completion were included. This analysis stratified patients based on Hb level at EPO initiation. Outcomes assessed included proportion of patients requiring RBC transfusion, mean treatment duration, and proportion of patients achieving an Hb = 11 g/dL. Results: 245 patients were eligible for analysis. 97 patients were initiated at a Hb < 10 g/dL and 148 patients were initiated at Hb 10–11 g/dL Baseline characteristics (age, gender distribution, weight, platinum-based therapy, Karnofsky score, primary tumor type) were similar except baseline Hb (9.4 g/dL v. 10.5 g/dL). Treatment duration was similar in both groups at approximately nine weeks. Transfusion outcomes and time to NCCN target Hb level (Hb =11 g/dL) are described in the table . Conclusions: This ongoing observational study demonstrated over two-thirds of patients achieved NCCN target Hb = 11 g/dL. Additional benefits for the patients initiated at Hb 10–11 g/dL were a shorter time to NCCN target Hb and a lower proportion of patients requiring transfusions. These results support the use of EPO for patients with chemotherapy-induced anemia and Hb < 11 g/dL.

[Table: see text]

No significant financial relationships to disclose.

Hematologic outcomes and drug cost considerations of erythropoiesis stimulating agents (ESTs) in cancer patients (pts) with fixed dosing regimens: Results from practice patterns in a prospective observational study

17063

Background: The erythropoietic agents available today have FDA-approval for weight-based as well as fixed dosing in cancer pts with chemotherapy-induced anemia [epoetin alfa (EPO) 40,000 Units QW, darbepoetin alfa (DARB) 500 mcg Q3W]. To understand hematologic outcomes and EST cost considerations based on actual patterns of use, not protocol-driven use, data were analyzed from the Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (D.O.S.E.) Registry, an ongoing registry of real-world practice. Methods: Data from 18 U.S. practice settings from 1/06–12/06 were assessed. Chemotherapy-treated adult cancer pts initiated at either EPO 40,000 Units or DARB 500 mcg were evaluated. Outcomes assessed included mean treatment duration, hematologic outcomes, mean administered dose, mean cumulative administered dose, and total EST cost (based on 9/2006 wholesale acquisition cost). Results: 168 pts (145 EPO, 23 DARB) were eligible. Patient groups were similar with regard to baseline age, gender distribution, tumor type, Karnofsky score and Hb. Treatment duration was similar for both agents, approximately 7 weeks. The proportion of pts transfused from Week 5 to end of study and number of units/ pt was not significantly different between groups (% transfused: EPO 10%, DARB 13%; Units/pt: EPO 0.2, DARB 0.3). Mean administered dose was 42,879 Units in the EPO group and 497 mcg in the DARB group. Mean cumulative administered dose for the treatment episode was 305,241 Units for EPO and 1,665 mcg for DARB, corresponding to an EST cost of $3,715 for EPO and $7,404 for DARB (p <.0001). Conclusions: Real-world practice pattern data from this observational study found similar treatment duration and transfusion patterns in the EPO-treated group versus the DARB-treated group in pts initiated with FDA-approved fixed dosing regimens. Cumulative EST cost was $3689 lower in the EPO group, a 50% reduction versus the DARB group.

No significant financial relationships to disclose.

Effect of recombinant human erythropoietin combined with granulocyte/ macrophage colony-stimulating factor in the treatment of patients with myelodysplastic syndrome. GM/EPO MDS Study Group

This randomized, placebo-controlled trial was designed to assess the efficacy and safety of therapy with granulocyte-macrophage colony-stimulating factor (GM-CSF) and erythropoietin (epoetin alfa) in anemic, neutropenic patients with myelodysplastic syndrome. Sixty-six patients were enrolled according to the following French-American-British classification: refractory anemia (20), refractory anemia with excess blasts (35), refractory anemia with ringed sideroblasts (9), and refractory anemia with excess blasts in transformation (2). Patients were stratified by their serum erythropoietin levels (less than or equal to 500 mU/mL, n = 37; greater than 500 mU/mL, n = 29) and randomized, in a 2:1 ratio, to either GM-CSF (0.3-5.0 microg/kg.d) + epoetin alfa (150 IU/kg 3 times/wk) or GM-CSF (0.3-5.0 microg/kg.d) + placebo (3 times/wk). The mean neutrophil count rose from 948 to 3831 during treatment with GM-CSF +/- epoetin alfa. Hemoglobin response (increase greater than or equal to 2 g/dL, unrelated to transfusion) occurred in 4 of 45 (9%) patients in the GM-CSF + epoetin alfa group compared with 1 of 21 (5%) patients with GM-CSF + placebo group (P = NS). Percentages of patients in the epoetin alfa and the placebo groups requiring transfusions of red blood cells were 60% and 92%, respectively, for the low-endogenous erythropoietin patients and 95% and 89% for the high-endogenous erythropoietin patients (P = NS). Similarly, the average numbers of units of red blood cells transfused during the 12-week study in the epoetin alfa and the placebo groups were 5.9 and 9.5, respectively, in the low-endogenous erythropoietin patients and 9.7 and 8.6 in the high-endogenous erythropoietin patients (P = NS). GM-CSF +/- epoetin alfa had no effect on mean platelet count. Treatment was well tolerated in most patients, though 10 withdrew from the study for reasons related predominantly to GM-CSF toxicity. (Blood. 2000;95:1175-1179)

Recombinant human erythropoietin therapy for anemic cancer patients receiving cisplatin chemotherapy

PURPOSE

To assess whether the administration of recombinant human erythropoietin (r-HuEPO) would increase the hematocrit, reduce the requirement for transfusion, and improve the quality of life in anemic cancer patients receiving myelosuppressive, cisplatin-based chemotherapy.

PATIENTS AND METHODS

One hundred thirty-two anemic cancer patients receiving cyclic, cisplatin-containing, myelosuppressive chemotherapy were evaluated. Patients received either r-HuEPO (150 U/kg) or placebo, subcutaneously, three times a week for 3 months. Responses were assessed by measuring changes in hemoglobin/hematocrit, transfusion requirement, and quality of life.

RESULTS

The mean hematocrit increased by 6.0 percentage points in the r-HuEPO group versus 1.3 in the placebo group. A decrease in transfusion requirement did not reach significance over all 3 months, but there was a significant reduction in the percentage of patients transfused in the second and third months (27% r-HuEPO vs. 56% placebo) and a trend toward reduction in the mean total number of units transfused (1.20 units r-HuEPO vs. 2.02 units placebo), suggesting a lag of 1 month before r-HuEPO can affect the transfusion requirement. Pretreatment serum erythropoietin levels were lower in responders than in nonresponders (73.5 IU/L and 86.3 IU/L means, respectively). However, the magnitude of this difference was not helpful in defining which patients were likely to respond. There was a significant improvement in overall quality of life between the two treatment arms in favor of the r-HuEPO-treated group. There were no significant adverse effects associated with r-HuEPO.

CONCLUSIONS

r-HuEPO is safe and can cause a significant improvement in the hematocrit and quality of life of anemic cancer patients receiving myelosuppressive, cisplatin-based chemotherapy. After 1 month of r-HuEPO, there is also a reduction in transfusion requirement.

The impact of prenatal care on the outcome of pregnancy

In a 12-months' prospective project all women delivering at the Soroka Medical Center, Beer-Sheba, Israel, were studied with regard to the type of prenatal care (P.C.) and the outcome of pregnancy. The Soroka Medical Center is the sole medical facility providing obstetric and neonatal services to the 300,000 inhabitants of the region. Prenatal care is delivered by a uniform network of 70 community-based stations. The availability, type and quality of services were uniform for all women and were not altered throughout the study period. The project encompassed 7308 deliveries. 2154 Bedouin women were excluded in order to avoid possible bias due to cultural and genetic characteristics. Data regarding 5154 Jewish women were analysed. Perinatal mortality was inversely proportional to the number of prenatal contacts. The uncorrected mortality rates were 12.7% in women entirely lacking P.C. and 6.2%, 1.9% and 1.0% in patients who had 1-6, 7-10 and 11 or more prenatal contacts respectively. The low-birthweight rate was significantly increased in women lacking prenatal care (22.8%) or having rudimentary care (17.4%) as compared to those who had 11 or more prenatal contacts with medical personnel (5.9%). Prenatal care reduced neonatal morbidity as expressed by the length of hospitalization, the frequency of infants with multiple diagnoses and the incidence of specific pathologies such as respiratory distress syndrome, light for dates and asphyxia. The incidence of some complications of pregnancy (abruptio placentae, premature labor, PROM) was significantly increased in women lacking P.C. or having inadequate P.C. (1-6 prenatal contacts). Moreover, lack of prenatal care was clearly connected with high-risk delivery, thus increasing the danger to the baby. It is suggested that many adverse effects of various socio-economic, genetic and general health factors may be diminished by proper prenatal care coupled with adequate obstetric and neonatal services.

Prognostic factors in polymyositis/dermatomyositis. A computer-assisted analysis of ninety-two cases

An effort was made to identify all patients with polymyositis/dermatomyositis (PM/DM) admitted to hospitals in Israel from 1956-1976. The diagnosis of PM/DM was retrospectively reviewed in 92 (46 definite, 26 probable, and 20 possible) cases. The most common complaints and physical findings in the course of the disease were muscle weakness (86 patients), rash (53 patients), arthritis or arthralgia (39 patients), and dysphagia (35 patients). Elevated serum aldolase levels were found in 64% of the patients for whom data were available; 92% had abnormal electromyogram results, and 60.9% had muscle histopathology consistent with PM/DM. Malignancy was diagnosed in 13 patients. Malignancy, ischemic heart disease, and pulmonary complications were the most common causes of death. The actuarial survival curve was heterogeneous, with an accelerated mortality during the first year after diagnosis and a slower mortality during the following 7 years. Independent unfavorable prognostic signs were: failure to induce remission, leukocytosis, fever, older age, a shorter disease history, and dysphagia.