Effectiveness and Safety of an Induction Therapy with Epoetin Alfa in Anemic Cancer Patients Receiving Concomitant Chemotherapy

BACKGROUND

Epoetin alfa, administered at standard dosages of 10,000-20,000 IU three times weekly or 40,000-60,000 IU once weekly, has been shown to significantly increase hemoglobin (Hb) levels, decrease transfusion requirements, and improve quality-of-life parameters in patients undergoing chemotherapy.Objective. This open-label, nonrandomized, historically controlled study was conducted to evaluate the efficacy and safety of an induction dose of epoetin alfa in patients with moderate or severe anemia who were receiving chemotherapy.

METHODS

Nineteen patients with solid tumors and Hb levels < 9.0 g/dl were enrolled. The patients received single s.c. injections of epoetin alfa, 40,000 IU, on study days 1, 4, 7, 10, and 13, and were then observed for the following 30 days. Nineteen other cancer patients who had matching characteristics and had received epoetin alfa, 10,000 IU, three times weekly for the 45-day study period, served as historical controls. The primary efficacy variable was change in Hb level from baseline to days 15 (approximately week 2) and 45 (approximately week 6.5). Secondary efficacy variables included the percent response (Hb increase > or = 1 g/dl) and percent major response (Hb increase > or = 2 g/dl) at days 15 and 45, the durations of response and major response after day 45, the proportion of patients transfused within the 45 study days, the changes in Eastern Cooperative Oncology Group performance status score at days 15 and 45, and the ability to maintain the planned chemotherapy dose (dose intensity) over the 45-day study.

RESULTS

Mean increases in Hb level in the epoetin alfa 40,000 IU group were significantly greater than those in the historical control group both at day 15 and at day 45. The increase in Hb level in the control group approximated increases reported with standard 3-times-weekly epoetin alfa at day 15 but was somewhat lower than the increases typically seen by day 45, presumably due to the fact that, in the present study, the epoetin alfa dose was not doubled in initial nonresponders, as is commonly done with standard epoetin alfa treatment. The rates of major response for epoetin alfa 40,000 IU patients (37% at day 15 and 84% at day 45) were higher than those for control patients (16% and 21%, respectively). Also, the transfusion rate was lower and performance status scores were better in the epoetin alfa 40,000 IU patients than in the control patients. In all, 74% of epoetin alfa 40,000 IU patients versus 47% of control patients received 100% of the planned chemotherapy dose. Epoetin alfa was well tolerated in both treatment groups.

CONCLUSIONS

Results of this study suggest that epoetin alfa at a dose of 40,000 IU administered five times over 2 weeks may confer even higher response rates than those seen with standard dosing regimens. These encouraging results support further study of the proposed induction dose of epoetin alfa in a larger, randomized, prospectively controlled trial.

Thymopentin treatment of rheumatoid arthritis

Although the etiology of rheumatoid arthritis (RA) is unknown, there is solid evidence that immunological factors play a pivotal role in its pathogenesis. It seems that a hyporeactivity of local (intraarticular) T-suppressor cells would permit an excessive immune response that ultimately leads to the classical symptoms and signs of inflammation and cartilage damage. Thymopentin is a synthetic pentapeptide (Arg-Lys-Asp-Val-Tyr) which represents the active biologic site (sequence 32-36) of the native thymic hormone thymopoietin, containing 49 amino acids. Thymopoietin and thymopentin have been shown to possess immuno-normalizing properties in a number of animal model systems. Low concentrations of the hormone characteristically stimulate the OKT4-positive cells, whereas higher concentrations additionally induce stimulation of OKT8-positive cells. This report summarizes the clinical experience collected by Italian investigators, and discusses the results with a view to previously published papers.

Management of viral infections with thymopentin

Recurrent herpes simplex-, herpes zoster- and human papilloma virus infections are sometimes difficult to control by traditional antiviral therapy. Although detectable immune disturbances are not regularly associated with the clinical presentation, a compromised cellular immunity has been found to play an important role in the pathogenesis of those diseases. Thymopentin (Arg-Lys-Asp-Val-Tyr) is a synthetic pentapeptide corresponding to the active structure of the natural 49 amino acids containing thymic hormone thymopoietin, which has shown impressive immunoregulatory activity in many animal model systems and human in-vitro tests. Cumulative clinical experience with this drug has suggested that it would be of particular value in certain recurrent viral diseases. This report summarizes some of the individual studies performed so far, and discusses the mechanisms of action within the context of relevant published articles in this field. Contrary to antiviral drugs, thymopentin's effect appears to be long-lasting also after discontinuation of treatment. The drug seems to be extremely safe and no serious adverse reactions have been reported to date.

[Evaluation of the use of thymopentin in patients with progressive systemic sclerosis]

Although the exact etiology of progressive systemic sclerosis (SSP) is still unknown, it is felt that immunologic disorders may be implicated in its pathogenesis. On the basis of these considerations, an open study with an immunomodulating drug, thymopentin, was performed in 20 SSP outpatients. These subjects were initially treated with thymopentin three times a week for three consecutive months (phase I); during a second study phase lasting three months, 10 patients continued to receive thymopentin and the remaining 10 placebo (phase II). A significant improvement in various clinical, laboratory and instrumental findings was seen following thymopentin treatment. During phase II, those on placebo regressed to basal conditions, while an added improvement was noted in those who continued with thymopentin.

Tolmetin sodium in clinical practice: a survey of 32,207 treated patients

A total of 32,207 patients with various rheumatic disorders were treated with the non-steroidal antiphlogistic tolmetin in the course of a post-marketing survey performed in Italy with the co-operation of 4,205 general practitioners. The treatment proved effective in about 90% of patients treated. The tolerability of the drug was excellent or good in 91% of cases. Side-effects involving mostly the gastro-intestinal tract occurred in 12.3% of cases, but treatment was discontinued in only 3.6% of patients. The results confirm the remarkable therapeutic activity and the good tolerability of tolmetin sodium.