Administration of erythropoietin during concurrent chemotherapy and radiation therapy for the treatment of non small cell lung cancer prevents anemia and reduces the number of red blood cell transfusions.

Combination chemotherapy and radiation therapy is a standard treatment modality for many patients with lung cancer. Side effects resulting from concurrent chemo-radiotherapy are dependent on the specific chemotherapy drugs and radiation dose utilized. The most common side effects experienced are bone marrow toxicity characterized by neutropenia, anemia, and esophagitis. Anemia occurs when there is a decrease in the hemoglobin necessary for transporting oxygen to the body’s tissues. Patients with anemia may experience fatigue, shortness of breath, and poor delivery of oxygen to tissues may impair the effect of radiation therapy. Because a highly effective concurrent chemotherapy and radiation therapy program for the treatment of non small cell lung cancer was associated with significant anemia in approximately 90% of patients, a clinical trial was initiated to evaluate whether erythropoietin, which stimulates the production of red blood cells, could improve or prevent the anemia associated with treatment of lung cancer.

In this project, 12 patients were treated with erythropoietin and iron supplementation concurrent with their chemo-radiotherapy of non small cell lung cancer. The effect of this treatment was then compared to patients treated with the identical chemo-radiotherapy without erythropoietin and iron supplementation. The 2 groups of patients that were compared had identical baseline hemoglobin levels; however, the group receiving erythropoietin and iron supplementation experienced only a minor drop in hemoglobin concentration and only 8% of patients required a red blood cell transfusion compared to approximately 40% of patients that were not treated with erythropoietin. This small clinical trial strongly suggests that erythropoietin and iron supplementation administered concurrently with chemo-radiotherapy for the treatment of non small cell lung cancer can decrease the severity of anemia and reduce red blood cell transfusion requirements. (Proceedings American Society of Clinical Oncology, Vol 17, Abstract 1780, 1998)

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