Strategy for the Use of Erythropoetin Alpha to Maintain Hemoglobin Level in Breast Cancer Patient Treated with Anthracycline-base of Adjuvant Chemotherapy | Achmad | International Journal of Integrated Health Sciences 102 350 1 PB
Original Aricle
Strategy for the Use of Erythropoein Alpha to Maintain Hemoglobin Level in Breast
Cancer Paient Treated with Anthracycline-base of Adjuvant Chemotherapy
Dimyai Achmad,1 Yusuf Hariady,1 Benny Isakh,1 Maman Abdurrahman,1 Ahmad Faried2
1
Department of Surgical Oncology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General
Hospital
2
Oncology and Stem Cell Working Group, Health Research Unit, Faculty of Medicine, Universitas PadjadjaranDr. Hasan Sadikin General Hospital
Abstract
Objecive: To evaluate the value of erythropoiein alpha (epoein) administraion,
as an alternaive treatment of anemia in the operable breast cancer paients.
Methods: This is a mulicenter phase III randomized clinical trial to evaluate the
value of epoein administraion among anemic breast cancer paients who are
undergoing anthracyclin-based adjuvant chemotherapy. Sixty four paients were
incuded in this trial with iniial hemoglobin (Hb) level of 10–12 g/dL. The paients
were randomly distributed into two groups: one group received aministraion of
40,000 IU epoein/week for six imes a week ater operaion and the other did
not. In the third week ater the operaion, both groups were started on a 6 cycles
of adjuvant chemotherapy with three weeks intervals. Hb levels were evaluated
during every chemotherapy cycle.
Results: The Hb levels in the epoein group were always above 10 g/dL up unil
the end of the sixth chemotherapy cycle or unil the twenty irst week post
operaion without blood transfusion.
Received:
September 18, 2012
Revised:
January 31, 2013
Accepted:
March 6, 2013
Conclusions: The administraion of epoein 3 weeks prior and 3 weeks ater the
irst cycles of chemotherapy, maintains a suicient/normal Hb level in breast
cancer paients receiving anthracycline-based chemotherapy.
Keywords: Anthracyclin-based chemotherapy, breast cancer, erythropoiein
alpha
IJIHS. 2013;1(1):8–12
Introducion
In the management of operable breast cancer
with histopathologically proven lymph nodes
metastasis, adjuvant chemotherapy has to be
given.1 For opimal adjuvant chemotherapy
result, drug type accuracy, dosage and consistent
schedule have to be obtained. However, the
inconsistency in therapy someimes occured
due to the side efects of chemotherapy on the
hematopoieic system, causing a decrease in
the hemoglobin level.
In several studies, some researchers reported
that anthracycline-based chemotherapy could
Correspondence:
Dimyai Achmad, Department of Surgical Oncology, Faculty
of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin
General Hospital
Jl. Pasteur No. 38, Bandung, Indonesia
e-mail: dimachmad@yahoo.com
8
lead to 4–63% of anemia, depending on the
number of chemotherapy cycles.2 It is also
reported that 25% paients who received 21-day
cyclophosphamide, epirubicin, 5-luorouracil
(CEF) regiment [600/60/600 mg/m2] developed
anemia.3 Other researchers have reported
that anemia occurred at the beginning of the
irst week of chemotherapy in 88.3% paients
receiving adriamycin-cyclophosphamide (AC)
regiments [60/600 mg/m2, three weekly].3 Blood
transfusion is the recommended treatment for
chemotherapy related anemia. The result is fast
achieved but the side efect of blood transfusion
should not be ignored. These side efects
ranging from allergic reacion to anaphylacic
shock with possible risks for viral infecions such
as hepaiis and human immunodeiciency virus
(HIV) infecions.4
In 2002, the American Society of Clinical
Oncology (ASCO) has recommended the usage
Internaional Journal of Integrated Health Sciences. 2013;1(1):8 ̶ 12
Dimyai Achmad, Yusuf Hariady, et al.
of erythropoiein alpha (epoein) as a therapy
for chemotherapy induced anemia.5 Epoein
boosts erythrocyte producion by proliferaing
and difereniaing the erythroid precursor in
the bone marrow. It also simulates reiculocyte
release from bone marrow and increases
cellular hemoglobin (Hb) synthesis due to colony
forming unit-erythroid (CFU-E) difereniaion
into erythroblast.6-10 ASCO recommended that
epoein treatment should be started when the
Hb level is ≥10 g/dL but also in mild anemia where
the Hb level is 10–12 g/dL. The recommended
dosage is 150 IU/kg, three imes a week or
40,000 IU once a week.5 Del Mastro and Venturini
reported that in 20–40% cases of paients with
Hb
Strategy for the Use of Erythropoein Alpha to Maintain Hemoglobin Level in Breast
Cancer Paient Treated with Anthracycline-base of Adjuvant Chemotherapy
Dimyai Achmad,1 Yusuf Hariady,1 Benny Isakh,1 Maman Abdurrahman,1 Ahmad Faried2
1
Department of Surgical Oncology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General
Hospital
2
Oncology and Stem Cell Working Group, Health Research Unit, Faculty of Medicine, Universitas PadjadjaranDr. Hasan Sadikin General Hospital
Abstract
Objecive: To evaluate the value of erythropoiein alpha (epoein) administraion,
as an alternaive treatment of anemia in the operable breast cancer paients.
Methods: This is a mulicenter phase III randomized clinical trial to evaluate the
value of epoein administraion among anemic breast cancer paients who are
undergoing anthracyclin-based adjuvant chemotherapy. Sixty four paients were
incuded in this trial with iniial hemoglobin (Hb) level of 10–12 g/dL. The paients
were randomly distributed into two groups: one group received aministraion of
40,000 IU epoein/week for six imes a week ater operaion and the other did
not. In the third week ater the operaion, both groups were started on a 6 cycles
of adjuvant chemotherapy with three weeks intervals. Hb levels were evaluated
during every chemotherapy cycle.
Results: The Hb levels in the epoein group were always above 10 g/dL up unil
the end of the sixth chemotherapy cycle or unil the twenty irst week post
operaion without blood transfusion.
Received:
September 18, 2012
Revised:
January 31, 2013
Accepted:
March 6, 2013
Conclusions: The administraion of epoein 3 weeks prior and 3 weeks ater the
irst cycles of chemotherapy, maintains a suicient/normal Hb level in breast
cancer paients receiving anthracycline-based chemotherapy.
Keywords: Anthracyclin-based chemotherapy, breast cancer, erythropoiein
alpha
IJIHS. 2013;1(1):8–12
Introducion
In the management of operable breast cancer
with histopathologically proven lymph nodes
metastasis, adjuvant chemotherapy has to be
given.1 For opimal adjuvant chemotherapy
result, drug type accuracy, dosage and consistent
schedule have to be obtained. However, the
inconsistency in therapy someimes occured
due to the side efects of chemotherapy on the
hematopoieic system, causing a decrease in
the hemoglobin level.
In several studies, some researchers reported
that anthracycline-based chemotherapy could
Correspondence:
Dimyai Achmad, Department of Surgical Oncology, Faculty
of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin
General Hospital
Jl. Pasteur No. 38, Bandung, Indonesia
e-mail: dimachmad@yahoo.com
8
lead to 4–63% of anemia, depending on the
number of chemotherapy cycles.2 It is also
reported that 25% paients who received 21-day
cyclophosphamide, epirubicin, 5-luorouracil
(CEF) regiment [600/60/600 mg/m2] developed
anemia.3 Other researchers have reported
that anemia occurred at the beginning of the
irst week of chemotherapy in 88.3% paients
receiving adriamycin-cyclophosphamide (AC)
regiments [60/600 mg/m2, three weekly].3 Blood
transfusion is the recommended treatment for
chemotherapy related anemia. The result is fast
achieved but the side efect of blood transfusion
should not be ignored. These side efects
ranging from allergic reacion to anaphylacic
shock with possible risks for viral infecions such
as hepaiis and human immunodeiciency virus
(HIV) infecions.4
In 2002, the American Society of Clinical
Oncology (ASCO) has recommended the usage
Internaional Journal of Integrated Health Sciences. 2013;1(1):8 ̶ 12
Dimyai Achmad, Yusuf Hariady, et al.
of erythropoiein alpha (epoein) as a therapy
for chemotherapy induced anemia.5 Epoein
boosts erythrocyte producion by proliferaing
and difereniaing the erythroid precursor in
the bone marrow. It also simulates reiculocyte
release from bone marrow and increases
cellular hemoglobin (Hb) synthesis due to colony
forming unit-erythroid (CFU-E) difereniaion
into erythroblast.6-10 ASCO recommended that
epoein treatment should be started when the
Hb level is ≥10 g/dL but also in mild anemia where
the Hb level is 10–12 g/dL. The recommended
dosage is 150 IU/kg, three imes a week or
40,000 IU once a week.5 Del Mastro and Venturini
reported that in 20–40% cases of paients with
Hb