This is very useful, thank you David.

What wonderful, useful information. The ability to click on key words (such as cytokines) greatly enhances it's value. Thank you.
Shirley

I absolutely loved the article, I was only wondering if there were any references to the use of epo and how effective it is in an acute clinical setting such as post traumatic and post surgical or during surgery when large quantities of blood are lost.
Also a question that most proffesionals will ask is how long does it take for the epo to have a beneficial effect?
Also is Hb parameter the most sensitive for determing improved oxygenation with Epo or are there more sensitive tests?

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Dr Amit Char
Editorial Team

Your questions have been addressed to some extent in the forum, or in medical articles posted on the website. Try typing "EPO" or another specific keyword for your query into the search box at the top of the page. You will be surprised at how much information there is. You can also click on "Medical Articles and Abstracts" under the "Resources" section in the menu at the left hand side of NoBlood's Home Page and scroll down the subject headings until you find something helpful.

Thank You, will do that, am putting together some info together on the subject that can answer physicians query immediately. Great to have such a large resource.

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Dr Amit Char
Editorial Team

What are the thoughts on the recent FDA warning (issued 3/9/07) regarding the use of EPO for those patients undergoing orthopaedic surgery?

The FDA was warning doctors not to try and reach normal H&H. with high doses of EPO. The reaching of a safe H&H should be ok. As we speak, doctors continue to use EPO safely.

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Jim Laws

I was wondering is EPO said to be unsafe with all forms of cancer in all doses? Or can it be used safely with certain forms of cancer or chemo related anemia? I've been getting conflicting information with St Jude's Children's Research Hospital saying it improves the efficacy in children with cancer.

While some information on the black box warnings given by the FDA and studies with a higher mortality rate confused me.

Erythropoiesis-stimulating agents in oncology. [J Natl Compr Canc Netw. 2008] - PubMed Result

J Natl Compr Canc Netw. 2008 Jul;6(6):565-75

Erythropoiesis-stimulating agents in oncology

Glaspy JA.
Division of Hematology-Oncology, UCLA School of Medicine, Los Angeles, California 90095-6956, USA. jglaspy@mednet.ucla.edu

Patients who have cancer, particularly those undergoing chemotherapy, frequently become anemic. Therapy with erythropoiesis-stimulating agents (ESAs) is associated with an increase in hemoglobin levels, a reduction in transfusion requirements, and, according to many clinical trialists and experienced clinicians, an improvement in functional status, productivity, and quality of life. Several randomized trials of ESAs in patients who have cancer have recently reported inferior outcomes in tumor progression or survival, raising appropriate concerns about the safety of ESAs in oncology. However, 3 important caveats to these reports exist. First, these clinical trials did not reflect the common use of ESAs in oncology practice (i.e., to treat, rather than prevent, anemia in patients undergoing chemotherapy). Second, the trials were seriously flawed and did not meet reasonable standards for cancer progression or survival trials. Third, during the same period, randomized trials were presented or published that showed no negative impact on tumor progression or survival; these trials have approximately the same shortcomings as trials that suggest a safety issue exists. The lack of definitive answers about the safety of ESAs for treating chemotherapy-related anemia has placed physicians, regulators, and most importantly patients in a difficult position that can only be addressed with additional data. This article reviews relevant preclinical and clinical available data to help improve understanding and guide decision making.

PMID: 18597710 [PubMed - indexed for MEDLINE]


An assessment of erythroid response to epoetin alp...[Cancer. 2009] - PubMed Result

Cancer. 2009 Feb 15;115(4):706-15

An assessment of erythroid response to epoetin alpha as a single agent versus in combination with granulocyte- or granulocyte-macrophage-colony-stimulating factor in myelodysplastic syndromes using a meta-analysis approach

Mundle S, Lefebvre P, Vekeman F, Duh MS, Rastogi R, Moyo V.
Medical Affairs, Centocor OrthoBiotech Services, LLC, Horsham, Pennsylvania, USA. suneelmundle@hotmail.com

BACKGROUND: Epoetin alpha (EPO) continues to be the initial treatment of choice for most anemic patients with myelodysplastic syndromes (MDS). Over the years, different therapeutic strategies have been adopted to optimize the clinical benefits of EPO in this setting. METHODS: In the current meta-analysis of published literature, erythroid response (ER) rates with EPO as a single agent versus its combination with granulocyte-colony-stimulating factor (G-CSF) or granulocyte-macrophage-colony-stimulating factor (GM-CSF) were compared. RESULTS: The assessment indicated that the ER rates were comparable between the 2 EPO-based therapeutic strategies. Furthermore, EPO monotherapy at a higher dose of 60,000 to 80,000 U weekly produced significantly higher ER rates (64.5%) compared with the standard oncology dose of 30,000 to 40,000 U weekly either as a single agent (49%; P < .001) or in combination with G-CSF/GM-CSF (50.6% P = .007). In addition, when transfusion-dependent patients were assessed separately, both EPO monotherapy and its combination with G-CSF/GM-CSF produced comparable and appreciable levels of transfusion independence (28.8% and 24.8%, respectively). CONCLUSIONS: In the current meta-analysis, higher doses of EPO demonstrated better ER rates compared with EPO at standard doses alone or in combination with G-CSF/GM-CSF. Furthermore, the authors concluded that prospective clinical studies are warranted to evaluate the use of higher doses of EPO in anemic patients with MDS. (c) 2009 American Cancer Society.

PMID: 19152429 [PubMed - indexed for MEDLINE]


Epoetin alfa 60,000 U once weekly followed by 120,...[Oncologist. 2004] - PubMed Result

Oncologist. 2004;9(1):90-6

Epoetin alfa 60,000 U once weekly followed by 120,000 U every 3 weeks increases and maintains hemoglobin levels in anemic cancer patients undergoing chemotherapy

Patton J, Kuzur M, Liggett W, Miranda F, Varsos H, Porter L.
Tennessee Oncology, Nashville, Tennessee 37211-8025, USA. jpatton@tnonc.com

PURPOSE: Epoetin alfa administered s.c. three times weekly or once weekly increases hemoglobin (Hb) levels, decreases transfusion requirements, and improves quality of life in anemic cancer patients receiving chemotherapy. This study assessed the feasibility of using higher initial doses of once-weekly epoetin alfa followed by less frequent maintenance doses to increase and then maintain adequate Hb levels in this population. MATERIALS AND METHODS: In this open-label, nonrandomized, pilot study, anemic (baseline Hb < or = 11 g/dl) cancer patients undergoing chemotherapy received initial doses of epoetin alfa of 60,000 U s.c. once weekly to increase Hb levels by at least 2 g/dl, followed by 120,000 U s.c. every 3 weeks to maintain Hb levels. The maximum treatment duration was 24 weeks. RESULTS: The mean baseline Hb level was 10.1 +/- 0.8 g/dl (n = 20). Once-weekly dosing resulted in mean Hb level increases of 1.0 +/- 1.1 g/dl by week 4 and 2.9 +/- 1.9 g/dl by week 8; 86% and 79% of patients evaluable at week 8 and week 12, respectively, demonstrated increases of at least 2 g/dl (target Hb level of > or = 12 g/dl). Thirteen patients (65%) received at least one maintenance dose; the mean Hb level increased from 12.8 +/- 1.1 g/dl before starting maintenance therapy to 13.3 +/- 1.4 g/dl at the last maintenance week. Both dosage regimens were well tolerated. CONCLUSIONS: Once-weekly epoetin alfa at a dose of 60,000 U effectively increased Hb levels by week 8; 86% of patients achieved rises of at least 2 g/dl or Hb levels > or = 12 g/dl. Moreover, epoetin alfa at doses of 120,000 U every 3 weeks maintained or increased Hb levels. Results from this pilot study suggest that higher initial once-weekly dosing of epoetin alfa followed by less frequent maintenance dosing appears to be feasible for treating anemia in cancer patients undergoing chemotherapy. Further evaluation of these and other epoetin alfa dosage regimens is warranted.

PMID: 14755018 [PubMed - indexed for MEDLINE]