Biosimilar epoetin for the management of chemotherapy-induced anemia in elderly patients

Abstract

IntroductionChemotherapy-induced anemia (CIA) is a frequent complication among cancer patients, with elderly patients more likely to suffer severe effects. Biosimilar erythropoiesis-stimulating agents lower costs of supportive cancer treatment, and thus are particularly relevant in the elderly cancer population, which is growing rapidly worldwide. The goal of this subanalysis was to compare the tolerability and effectiveness of an epoetin biosimilar for treating CIA in patients <70 years old vs patients ≥70 years old.Materials and methodsThe ORHEO observational trial enrolled patients with CIA (hemoglobin [Hb] <11 g/dL) in association with chemotherapy for solid tumors, lymphoma, or myeloma. Patients received an epoetin biosimilar and were evaluated at 3 and 6 months for response, defined as achieving target Hb without blood transfusions during the 3 weeks preceding measurement, Hb ≥10 g/dL, or Hb increase ≥1 g/dL since study enrollment. Secondary end points included changes in Hb level, treatment interruptions, transfusion rates, and adverse events.ResultsAmong the 2,310 original patients, 1,301 <70 years old were compared to 1,009 ≥70 years old. Almost all patients (99.9%) received the biosimilar epoetin zeta (Retacrit). Patients in both groups responded well to treatment with biosimilar epoetin, with 79.8% and 84% responding at 3 months and 86.3% and 86.8% at 6 months among younger and elderly cohorts, respectively. Biosimilar epoetin therapy was well tolerated, with adverse events reported in only 17.6% and 16.4% of younger and elderly patients, respectively. A greater number of thromboembolic events and a lesser rate of infections were reported in the elderly, but were still lower than reported in clinical registration trials. No treatment fatalities occurred in either group.ConclusionBiosimilar epoetin was an effective and well-tolerated treatment for managing CIA in elderly cancer patients.

Results of darbepoetin alfa treatment of anaemia in chemotherapy-receiving breast cancer patients: a single-centre retrospective observational study

“…No statistically significant age-related differences were found in the effectiveness of ESA administration. Similar conclusions have been presented by other authors [13,23].…”

“…Numerous publications emphasize the necessity of a concurrent iron supplementation which improves ESA effectiveness [8,9,16,19,23].…”

“…The incidence of anaemia increases with age and some studies point to a significant growth in the incidence of anaemia in patients over 70 years of age [22]. Anaemia in the elderly leads to an increased number of falls as well as depression [23]. Although CIA is a common complication observed during chemotherapy of elderly patients, there is no information on a systematic clinical response to ESA in the elderly [23].…”

“…Anaemia in the elderly leads to an increased number of falls as well as depression [23]. Although CIA is a common complication observed during chemotherapy of elderly patients, there is no information on a systematic clinical response to ESA in the elderly [23]. That is why this study strived to assess the effectiveness of the treatment with darbepoetin alfa in two age groups: below 65 years of age and 65 and more years of age.…”

Prognostic Significance of Blood Transfusion in Newly Diagnosed Multiple Myeloma Patients without Autologous Hematopoietic Stem Cell Transplantation

“…In recent years, some studies showed that usage of ESAs could increase the hemoglobin level of MM patients with good tolerance during chemotherapy and might lead to the reduction of RBC transfusion [ 20 , 21 ]. So, ESAs are recommended as an adjunct to transfusions or alternative in MM therapy to increase the patients' tolerance to chemotherapy and decrease the consumption of blood products.…”