Epoetin Alfa in Treating Patients With Anemia Who Are Undergoing Chemotherapy for Cancer

A Pilot Trial of Extended Interval Dosing of Epoetin Alfa (Procrit®) for the Treatment of Anemia in Oncology Patients

RATIONALE: Epoetin alfa may cause the body to make more red blood cells. It is used to treat anemia caused by cancer and chemotherapy. It may also help relieve fatigue in patients with anemia.

PURPOSE: This randomized clinical trial is studying how well epoetin alfa works in treating patients with anemia who are undergoing chemotherapy for cancer.

OBJECTIVES:

Primary

• Determine the efficacy, in terms of maintenance of target hemoglobin and hematocrit levels, of interval dosing with epoetin alfa in treating patients with anemia undergoing chemotherapy for nonhematologic cancer.

Secondary

• Determine the pharmacokinetics and pharmacodynamics of this drug in these patients.
• Correlate hemoglobin and hematocrit response with patient age (> 65 years vs < 65 years) in patients treated with this drug.
• Determine quality of life of patients treated with this drug.
• Determine the adverse effects of this drug in these patients.
• Determine the change over time of symptom and quality of life variables (e.g., fatigue) in patients treated with this drug.

OUTLINE: This is a partially randomized, pilot study. Patients are stratified according to age (< 65 years vs ≥ 65 years). Patients are assigned to 1 of 2 treatment groups based on participation in the pharmacokinetic (PK) portion of the study.

• Group 1 (PK study, initial therapy): Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Five patients receive epoetin alfa subcutaneously (SC) once weekly. Treatment continues for 24 weeks in the absence of unacceptable toxicity.
  • Arm II: Five patients receive epoetin alfa SC once weekly until hematocrit is > 36% OR hemoglobin reaches a value of 12 g/dL. Patients then proceed to maintenance therapy.

Patients in both arms also undergo PK sampling periodically during study treatment.

• Group 2 (non-PK study, initial therapy): Fifteen patients receive epoetin alfa SC once weekly until hematocrit is > 36% OR hemoglobin reaches a value of 12 g/dL. Patients then proceed to maintenance therapy.
• Maintenance therapy: Patients receive epoetin alfa SC once every other week for up to 24 weeks of total treatment (including both initial therapy and maintenance therapy). Patients whose blood counts fall below the critical levels are placed on a weekly dosing schedule. Patients whose blood counts rise too high discontinue study drug until blood counts are reduced.

Quality of life (including fatigue) is assessed at baseline and then every 4 weeks for 28 weeks.

After completion of study therapy, patients are followed at 4 weeks.

PROJECTED ACCRUAL: A total of 25 patients will be accrued for this study.

ELIGIBILITY CRITERIA

• 18 years of age or greater
• Must have Hb less than 11 g/dl and normal hematopoesis
• Must have non-myeloid malignancies treated with myelosuppressive therapy *Must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
• Must have a life expectancy of 6 months or greater
• Must have adequate liver function (bilirubin less than or equal to 2.0 mg) and renal function (creatinine less than or equal to 2.0 mg)
• Must have normal serum folate and vitamin B12 levels or be receiving replacement therapy
• Must be iron replete (transferring saturation great than or equal to 20 percent and ferritin greater than or equal to 100 mg/ml) or be receiving replacement therapy
• Must be able to fully comprehend and give written consent.
• Female patients with reproductive potential must be practicing an effective method of birth control (e.g., abstinence, prescription oral contraceptives, contraceptive injections, intrauterine device, double-barrier method, contraceptive patch, surgical sterilization) before entry and throughout the study.
• Female patients with reproductive potential must have a negative serum human chorionic gonadotropin (HCG) pregnancy test at screening (within 7 days before the first dose of study drug)

Exclusion criteria

• Patient has uncontrolled hypertension
• Patient has history of symptomatic cardiac disease
• Patient has serious intercurrent illness
• The patient is pregnant, has a positive serum HCG or is lactating Patient has known hypersensitivity to mammalian cell-derived products or human albumin.
• Patient has diagnosis of polycythemia vera, chronic myelogenous leukemia, myelodysplastic syndrome
• May not be due for transplant within 24 weeks
• Anemia due to factors other than cancer.
• History of a thrombotic vascular event.
• History of seizures
• Patient has received a red blood cell growth factor (epoetin alfa or darbepoetin) within the last 60 days