title: Pre-treatment erythropoietin levels cannot be used to predict individual response to epoetin alfa in anaemic cancer patients.
abstract: Recombinant human erythropoietin (epoetin alfa) is an effective treatment for anaemia in cancer patients, and over two-thirds of recipients experience a substantial increase in haemoglobin concentration (>2 g/dl). However, it would be helpful to identify responders before starting treatment. Some studies have suggested that high pre-treatment levels of endogenous erythropoietin pre-treatment levels of endogenous erythropoietin or other pre-treatment or early response variables are associated with a poor response to epoetin alfa, and several predictive algorithms have been published. We analysed data pooled from 9 clinical trials of 1010 patients to determine the clinical usefulness of pre-treatment erythropoietin levels and other variables for predicting response. This showed that pre-treatment factors alone do not provide a clinically useful prediction of response. The sensitivity of these models increases slightly if early response variables, such as the change in haemoglobin after 4 weeks, are included, but specificity remains poor. We conclude that, while there may be a statistical relationship between certain factors and response, none approach clinically useful levels of sensitivity or specificity.
mesh_terms: D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects; D004311:Double-Blind Method; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000097:blood* / Q000627:therapeutic use*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D010919:Placebos; D011994:Recombinant Proteins
chemical_list: D000970:Antineoplastic Agents; D010919:Placebos; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa