Clinical and in vitro effects of recombinant human erythropoietin in patients receiving intensive chemotherapy for small-cell lung cancer.
OBJECTIVE
Recombinant human erythropoietin (r-Hu-EPO) is known to be effective in untreated cancer patients. Here we assess the possibility that r-Hu-EPO may also prevent or reduce anemia in patients who receive cytotoxic chemotherapy.


METHODS
Thirty-six patients with small-cell lung carcinoma (SCLC) were enrolled onto a three-arm, randomized trial to investigate the effect of r-Hu-EPO on hemoglobin (Hb) levels and RBC and platelet (Plt) transfusions during chemotherapy. Bone marrow progenitors were studied before and after treatment. Two groups of patients received r-Hu-EPO at a dose of either 150 IU/kg (group 150) or 300 IU/kg (group 300) three times per week for the duration of chemotherapy. A control group did not receive r-Hu-EPO (group O). A maximum of six cycles of a chemotherapy regimen that consisted of vincristine, ifosfamide, carboplatin, and etoposide (VICE) were given to all patients. Hematologic parameters were measured weekly, and RBC or Plt transfusions were given for Hb levels less than 9 g/dL and Plt counts less than 20 x 10(9)/L.


RESULTS
Hb levels decreased in all patients, but onset of anemia was delayed in groups that received r-Hu-EPO (P = .002). A total of 116 U RBC were transfused in group 0, 54 in group 150, and 52 in group 300 (P = .017). In addition, there was a nonsignificant trend toward higher Plt counts and fewer Plt transfusions in patients who received r-Hu-EPO.


CONCLUSIONS
r-Hu-EPO at a dose of either 150 or 300 IU/kg three times weekly delays the onset of anemia and reduces RBC transfusion requirements in patients who undergo intensive chemotherapy for SCLC. A possible effect of r-Hu-EPO on platelet numbers deserves further study.
de Campos
E
E
Cancer Research Campaign Department of Medical Oncology, Christie Hospital, Manchester, United Kingdom.
Radford
J
J
Steward
W
W
Milroy
R
R
Dougal
M
M
Swindell
R
R
Testa
N
N
Thatcher
N
N
D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016190:Carboplatin / Q000009:adverse effects; D018288:Carcinoma, Small Cell / Q000097:blood / Q000188:drug therapy*; D003114:Colony-Forming Units Assay; D004334:Drug Administration Schedule; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000627:therapeutic use*; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006098:Granulocytes / Q000187:drug effects; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D007501:Iron / Q000097:blood; D007958:Leukocyte Count / Q000187:drug effects; D008175:Lung Neoplasms / Q000097:blood / Q000188:drug therapy*; D008264:Macrophages / Q000187:drug effects; D008297:Male; D015080:Mesna / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D010976:Platelet Count / Q000187:drug effects; D017713:Platelet Transfusion; D011994:Recombinant Proteins / Q000627:therapeutic use; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D011994:Recombinant Proteins; D004921:Erythropoietin; D014750:Vincristine; D005047:Etoposide; D006441:Hemoglobin A; D016190:Carboplatin; D007501:Iron; D015080:Mesna; D007069:Ifosfamide