Epoetin alfa improves anemia associated with chemotherapy in breast cancer patients

In this study, researchers examined the effect of epoetin alfa (Epogen; Procrit) on anemia (low count of red blood cells) caused by chemotherapy in breast cancer patients.

Breast cancer is caused by a defect that makes some breast cancer cells grow and multiply rapidly. One of the treatment options for patients with breast cancer is chemotherapy. Because chemotherapy targets fast-growing cancer cells, it can also destroy non-cancerous fast-growing cells, such as the red blood cells. Red blood cells contain a protein called hemoglobin (Hb) which helps red blood cells carry oxygen to the tissues and organs of the body. An insufficient oxygen supply to the body can lead to headaches, tiredness, difficulty to concentrate or think or heart problems. Thus, a low count of red blood cells, a condition called anemia, can be dangerous. When a patient’s Hb levels drop too low, they may require a blood transfusion to replace the lost red blood cells. Some medications such as erythropoiesis stimulating agents or EPAs can stimulate the body to produce its own extra red blood cells. However, recent studies disagree on whether these medications are safe. Therefore, it is important to understand how well EPAs, such as epoetin alfa, improve anemia and whether they affect survival for breast cancer patients treated with chemotherapy.

During a chemotherapy trial, 643 breast cancer patients received IDD-ETC chemotherapy (intense dose-dense chemotherapy with epirubicin (E), paclitaxel (T), and cyclophosphamide (C)). Half of these patients (324 people) also received epoetin alfa and half (319 people) received no medication for anemia. After 9 cycles of chemotherapy (21 weeks), Hb levels in the group not receiving epoetin alfa were significantly lower, indicating that these patients were more likely to develop anemia. Hb levels did not decline in the group receiving epoetin alfa. Furthermore, the group not receiving epoetin alfa was twice as likely to require a blood transfusion (28.1% vs. 12.8%). However, the epoetin alfa group was more likely to experience blood clots, a dangerous side effect (13% vs. 7%). Five years after chemotherapy, there was no difference in survival between groups, indicating that epoetin alfa is generally a safe addition to chemotherapy.

In summary, epoetin alfa lowers risk of anemia associated with chemotherapy in breast cancer patients, but it is associated with an increased risk of blood clots.

This study was funded in part by Johnson & Johnson, the manufacturer epoetin alfa.

Ask your doctor whether receiving epoetin alfa during your chemotherapy treatment to prevent anemia is a good option in your situation.