Randomized, open-label comparison of epoetin alfa extended dosing (80000U Q2W) vs weekly dosing (40000U QW) in patients with chemotherapy-induced anemia

Objective: This randomized, open-label, multicenter study compared the efficacy and safety of epoetin alfa (EPO) 80 000U every 2 weeks (Q2W) to the FDA-approved regimen of 40 000U weekly (QW) in patients with chemotherapy-induced anemia. Research design and methods: A total of 310 patients with nonmyeloid malignancy and baseline hemoglobin (Hb) <= 11g/dL who were scheduled to receive chemotherapy for a minimum of 12 weeks were randomized to EPO Q2W or QW for up to 12 weeks, with dose modification to maintain Hb at approximately 12 g/dL. Efficacy analyses used the per-protocol population ( patients who completed the study with a value for Hb change) for the primary endpoint only and the modified intent-to-treat (mITT) population ( patients who received study drug and had at least one postbaseline Hb value) for the primary and secondary endpoints. Results: Analysis of the primary endpoint revealed that the mean change in Hb from baseline to study end was comparable between the Q2W and QW groups in the per-protocol population (1.6 g/dL vs 1.8 g/dL, respectively; treatment difference, -0.2 g/dL; one-sided 95% confidence interval [-0.56, -]); similar results were observed in the mITT population. Among patients on study at Day 29, 9.6% (13/135) and 11.1% (14/126) of patients in the Q2W and QW groups, respectively, received a transfusion between Day 29 and the end of the study (p = 0.709). Dose withholds (21% vs 42%, p < 0.001) and dose reductions (41% vs 59%, p = 0.003) were less common for Q2W than QW. Safety profiles were similar between groups; clinically relevant thrombotic vascular events occurred in 8% of patients in each group. The open-label dosing and the patient attrition rate did not appear to influence overall study results. Conclusions: Extended dosing (80 000U Q2W) and once-weekly dosing (40 000U QW) of EPO provided comparable safety and efficacy for chemotherapy-induced anemia.