Biesma Bonne, van de Werf Paul R, Melissant Christian F, Brok Ronald G P M
Jeroen Bosch Hospital, Department of Pulmonary Diseases, Tolbrugstraat 11, 5211 RW 's-Hertogenbosch, The Netherlands.
Lung Cancer. 2007 Oct;58(1):104-11. doi: 10.1016/j.lungcan.2007.05.007. Epub 2007 Jun 29.
Anaemia seriously threatens the quality of life (QOL) in cancer patients receiving chemotherapy. In this article results are presented on the lung cancer population from a Dutch observational study. This study addressed the real-life situation of recombinant human erythropoietin (r-Hu-EPO or epoetin alfa) treatment in anaemic cancer patients receiving chemotherapy, with a focus on efficacy. In total 781 patients were enrolled in the observational study, including 382 patients with lung cancer. At enrolment patients were receiving epoetin alfa treatment and/or patients had a haemoglobin (Hb) level </=11.3g/dl. Analysis was focused on lung cancer patients who were treated with epoetin alfa (n=343). Type of cancer, chemotherapy agents, type of anaemia management and Hb levels were documented. Hb development was analysed and the effect of epoetin alfa treatment was investigated. In total 343 lung cancer patients were treated with epoetin alfa: 210 patients with non-small cell lung cancer (NSCLC) and 133 patients with small cell lung cancer (SCLC). The majority of patients (99.4%) received 40,000 IU epoetin alfa once weekly. Before epoetin alfa treatment was started during chemotherapy, Hb levels decreased with a rate of 1.3g/dl per 4 weeks, both for NSCLC as well as for SCLC. Epoetin alfa treatment was started on average at an Hb level of 10.6g/dl for NSCLC and 10.4g/dl for SCLC, respectively. Hb increases of 0.5-0.6g/dl per 4 weeks and 0.2g/dl per 4 weeks were reached for NSCLC and SCLC, respectively. Although significant increases of Hb levels were reached, the epoetin alfa treatment could not fully correct the Hb decrease which had taken place during chemotherapy before the start of epoetin alfa, resulting in suboptimal Hb levels. In contrast, early intervention with epoetin alfa (start in first week of chemotherapy at Hb>11.3g/dl) was especially effective for NSCLC patients where it resulted in a stabilization of Hb at baseline level. For SCLC patients this strategy was less effective. Furthermore, early intervention seemed to diminish the need for a blood transfusion, i.e., the higher the Hb at epoetin initiation the more patients did not receive any blood transfusion. Results from this observational study demonstrate that epoetin alfa treatment corrects chemotherapy-related anaemia in both NSCLC as well as SCLC patients. Early epoetin alfa intervention seems advantageous for lung cancer patients both in terms of maintaining adequate Hb levels during chemotherapy as well as reducing transfusions.
贫血严重威胁着接受化疗的癌症患者的生活质量（QOL）。本文展示了一项荷兰观察性研究中肺癌患者群体的研究结果。该研究探讨了重组人促红细胞生成素（r-Hu-EPO或阿法依泊汀）治疗接受化疗的贫血癌症患者的实际情况，重点关注疗效。共有781名患者参与了这项观察性研究，其中包括382名肺癌患者。入组时患者正在接受阿法依泊汀治疗和/或患者血红蛋白（Hb）水平≤11.3g/dl。分析集中于接受阿法依泊汀治疗的肺癌患者（n = 343）。记录了癌症类型、化疗药物、贫血管理类型和Hb水平。分析了Hb的变化情况，并研究了阿法依泊汀治疗的效果。共有343名肺癌患者接受了阿法依泊汀治疗：210名非小细胞肺癌（NSCLC）患者和133名小细胞肺癌（SCLC）患者。大多数患者（99.4%）每周一次接受40,000IU阿法依泊汀。在化疗期间开始阿法依泊汀治疗之前，NSCLC和SCLC患者的Hb水平均以每4周1.3g/dl的速度下降。阿法依泊汀治疗分别在NSCLC患者Hb水平平均为10.6g/dl、SCLC患者Hb水平平均为10.4g/dl时开始。NSCLC和SCLC患者的Hb分别每4周增加0.5 - 0.6g/dl和0.2g/dl。尽管Hb水平有显著升高，但阿法依泊汀治疗未能完全纠正阿法依泊汀开始治疗前化疗期间发生的Hb下降，导致Hb水平未达最佳。相比之下，阿法依泊汀的早期干预（在化疗第一周Hb>11.3g/dl时开始）对NSCLC患者特别有效，可使Hb稳定在基线水平。对于SCLC患者，该策略效果较差。此外，早期干预似乎减少了输血需求，即阿法依泊汀开始治疗时Hb越高，未接受任何输血的患者越多。这项观察性研究的结果表明，阿法依泊汀治疗可纠正NSCLC和SCLC患者化疗相关的贫血。阿法依泊汀的早期干预在化疗期间维持足够的Hb水平以及减少输血方面对肺癌患者似乎都具有优势。
