Epoetin Alfa: To Give or Not to Give

Extract

In this issue of the Journal, Moebus et al. (1) reported that an erythropoiesis stimulation agent (ESA) can safely treat chemotherapy-induced anemia in breast cancer patients receiving adjuvant therapy. Earlier evidence of a potentially negative effect on outcomes has made this treatment controversial, and ESAs in general have not been indicated for use in the curative setting. The setting for their report was an Arbeitsgemeinschaft Gynokologische Onkologie (AGO) phase III randomized trial that tested dose intensity and density for 1284 patients with 4 or more positive nodes. Half were randomly assigned to treatment with intense dose-dense (IDD) epirubicin (E at 150mg/m²) × 3 → paclitaxel (T at 225mg/m²) × 3 → cyclophosphamide (C at 2500mg/m²) × 3, all administered every 2 weeks with granulocyte colony stimulating factor and the other half to EC (90/600mg/m²) × 4 → P (175mg/m²) × 4 every 3 weeks (2). At a median follow-up of 5 years, the relapse-free survival (RFS; 70% vs 62%; P < .001) and overall survival (OS; 82% vs 77%; P = .03) were in favor of IDD chemotherapy. Not surprisingly, there were more nonhematologic and hematologic toxicities with the IDD regimen. With a longer follow-up of 10 years, these benefits were still maintained (3).