Resumen de Chemotherapy induced-anemia treated with erythropoetin alpha or dabopoetin in non-small cell lung cancer patients

Joan Manuel Gasent Blesa, Jaime E. Poquet Jornet, Vicente Giner, Cristina Cuesta Grueso, A. Munilla Das

• Introduction: Retrospective study aimed to analyse the response of chemotherapy induced anaemia (CIA) to erythropoietic-stimulating factors (EPO) in patients with advanced non-small-cell lung carcinoma (NSCLC).

  Method: Patients diagnosed with advanced NSCLC, normal haemoglobin and iron levels at baseline, and who developed anaemia during the chemotherapy treatment and received EPO were evaluated. EPO was indicated when haemoglobin level fell below 11 g/dl, and stopped if 12 g/dl were achieved. Two groups of patients were compared, those who responded to treatment (R), versus those who progressed (P).

  Results: We included 57 patients, 41 males (71.9%). We found 21 squamous cell carcinoma, 26 adenocarcinomas, four large cell carcinomas and six not specified. Mean age was 60.3 years (95% CI: 57.2-63.4). About the treatment they received, 52 patients received platinum plus gemcitabine and five patients cisplatin plus paclitaxel. Seventeen patients received treatment with erythropoietin alpha 40,000 IU weekly and 40 patients with darbepoetin 500 mcg three times a week. Patients non-responders (30 patients) developed anaemia significantly before (100% by the 4th cycle and 50% within 2nd vs. 100% within five second cycle and 7.4% by 2; p <0.001), presented significantly lower haemoglobin levels at the time of initiation of EPO (8.89 vs. 9.82 g/dl, p = 0.009) and lower response-rate to treatment with EPO (3.3% vs. 25.9%, p = 0.014). No significant differences in the rate of transfusion between responders and non-responders (14.8% R vs. 30% P, p = 0.172). The average increase in haemoglobin levels in each cycle of chemotherapy and EPO was 0.25 gr/dl for those who progressed vs. 0.74 gr/dl for those who respond to treatment (p <0.001, 95% CI: 0.232-0.748 OR). Average number of absolute increase in haemoglobin was significantly higher in responders (1.49 g/dl vs. 0.7 g/dl, p = 0.008, 95% CI: 0.21-1.368).

  Conclusions: The effectiveness of the treatment of chemotherapy-induced anaemia with EPO could predict the tumour response to chemotherapy. Correction of chemotherapy-induced anaemia with EPO may be a surrogate marker of disease control