According to results recently presented at the 27th San Antonio Breast Cancer Symposium (SABCS), Aranesp® (darbepoetin alfa) can be highly effective in preventing chemotherapy-induced anemia in patients undergoing neoadjuvant chemotherapy for breast cancer.

Patients with early breast cancer may be offered treatment with neoadjuvant chemotherapy, which is chemotherapy that is administered prior to the surgical removal of the cancer. The chemotherapy combination consisting of Taxotere® (docetaxel), cyclophosphamide and doxorubicin (TAC) is a highly effective treatment option for neoadjuvant therapy in breast cancer. However, TAC induces a high rate of anemia, with approximately 70% of patients treated with TAC ultimately suffering from the side effect. Researchers are currently evaluating ways to provide early treatment or prevention of anemia rather than trying to treat it once it has become severe.

Anemia is a term that refers to low levels of circulating red blood cells (RBCs) in the blood. Red blood cells are responsible for delivering oxygen to tissues throughout the entire body. Bone marrow (spongy material inside large bones) is stimulated to produce RBCs by a chemical substance called erythropoietin, which is secreted by the kidneys. Each RBC contains many molecules of hemoglobin, a protein-iron complex that is responsible for the delivery of oxygen to the cells and carbon dioxide to the lungs. Hemoglobin levels are often measured as an indicator of anemia, with levels of less than 12 g/dL being considered a sign of anemia.

Common symptoms caused by anemia include severe fatigue, shortness of breath, greatly diminished activity levels and a reduced overall feeling of well-being. Severe anemia often necessitates blood transfusions, which have associated risks of infection, rejection and increased medical costs. Furthermore, severe anemia may cause a delay in the dose of cancer treatment, resulting in suboptimal chances of a cure or optimal long-term survival.

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Erythropoietin can be manufactured outside the body and administered to patients. Recombinant human erythropoietin, or epoetin alfa, is a commonly used drug for cancer patients receiving treatment and is comprised of manufactured erythropoietin. Epoetin alfa has been shown to reduce the severity of anemia and reduce symptoms of fatigue in patients receiving treatment by stimulating the bone marrow to produce more RBCs. Currently, Aranesp® and Procrit® are two forms of epoetin alfa most often utilized for the treatment of anemia in the United States. Aranesp®, which requires less frequent dosing than Procrit®, has been approved by the FDA for the treatment of anemia caused by chemotherapy in non-myeloid cancers, or cancers that do not originate in blood cells. Less frequent dosing results in fewer injections and fewer office visits for patients, reducing the need for patients and caregivers to take time off from work or leisure. Furthermore, this allows caregivers to spend less time scheduling appointments and giving inpatient care to treat anemia and more time to attend to other patients and work-related activities. The use of Aranesp® is gaining momentum in the clinical setting as results from clinical trials continue to indicate its effectiveness in comparison to epoetin alfa.

Researchers from Germany recently conducted a trial to evaluate Aranesp® in the prevention of chemotherapy-induced anemia in breast cancer patients. This trial included 35 patients who were being treated with neoadjuvant therapy including TAC. Aranesp® was administered on the first day of chemotherapy, and once every 3 weeks. Aranesp® was discontinued if hemoglobin levels were greater than 14 g/dl. On the last day of the last cycle of chemotherapy, only 4 patients (11.4%) had a hemoglobin level of less than 12 g/dl. However, these patients had only mild anemia and no blood transfusions were required.

The researchers concluded that Aranesp® appears highly effective in preventing chemotherapy-induced anemia in breast cancer patients undergoing neoadjuvant therapy with TAC. Future trials will further confirm the role of Aranesp® in anemia prevention for cancer. Breast cancer patients who are to undergo chemotherapy and/or radiation, or who are anemic, may wish to speak with their physician regarding their individual risks and benefits of treatment including Aranesp®.

Reference: von Minckwitz G, Loibl S, Petrich S, et al. Primary prophylaxis with 3 weekly Darbepoetin alfa effectively prevents anaemia during neoadjuvant chemotherapy with docetaxel/doxorubicin/cyclophosphamide (TAC) in breast cancer patients. Proceedings from the 27th annual San Antonio Breast Cancer Symposium. December 2004. Abstract #6033.

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