Magazine article Drug Topics

Treatment of Cancer-Related Anemia to Call for Fewer Doses

Magazine article Drug Topics

Treatment of Cancer-Related Anemia to Call for Fewer Doses

Article excerpt

HOSPITAL PRACTICE

A streamlined new treatment for chemotherapy-induced anemia in patients with nonmyeloid malignancies has just won marketing approval from the Food & Drug Administration. Last year, the FDA OK'd the agent for use in anemia related to chronic renal failure.

Aranesp (darbepoetin alfa, Amgen) is a recombinant erythropoietic protein that requires fewer injections than standard treatment. In fact, managing anemia with darbepoetin alfa may involve a single dose of drug per chemotherapy cycle. That is, patients can now receive darbepoetin alfa once every three or four weeks-- compared with once a week with epoetin alfa (Procrit, Ortho Biotech), the conventional therapy.

The new drug apparently works equally well correcting the chronic anemia of cancer in patients not receiving chemotherapy-which afflicts some 400,000 Americans-- researchers noted at the annual meeting of the recent American Society of Clinical Oncology in Orlando, Fla. As yet there is no approved treatment for the chronic anemia of cancer itself.

Scientists showed that an adjustment in the amino acid structure of the original compound-adding two new glycosylation sites-makes longer treatment intervals feasible, extending darbepoetin alfa's half-life at least three times beyond that of epoetin alfa.

"The improved design enables clinicians to administer the new compound one-third less often than conventional therapy for the same therapeutic effect," explained lead researcher John A. Glaspy, M.D., M.P.H., director of the Bowyer Oncology Outpatient Clinic and associate chief of the division of hematology and oncology, UCLA School of Medicine. "With conventional therapy, usually some 50% to 60% of patients respond," he said. But the median time to response is 10 weeks. "The average duration of erythropoietic therapy in this setting is about 18 weeks-[not good for patients] who remain symptomatic for much of the treatment duration, and many do not respond at all."

Glaspy's new data, from a 12-week study involving 122 anemic patients, showed that those who received darbepoetin alfa in a four-week loading dose followed by an eight-week much lower maintenance dose had a substantial increase in hemoglobin. "In fact, after only four weeks of treatment, it was 80% greater than in those receiving Procrit," he emphasized. Further, this phase III study showed that after 12 weeks, less than 50% of patients responded to epoetin therapy, compared with more than 60% treated with the new drug-- even when the epoetin dosage was increased to try to stimulate an adequate response.

"Should our results be confirmed in large, rigorous, controlled studies," Glaspy added in an interview, "the new paradigm could entirely change the treatment of anemia in cancer patients. …

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