Effect of Epoetin Alfa on Survival and Cancer Treatment-Related Anemia and Fatigue in Patients Receiving Radical Radiotherapy With Curative Intent for Head and Neck Cancer

Purpose To evaluate the effect of epoetin alfa on local disease-free survival (DFS), overall survival ( OS), and cancer treatment-related anemia and fatigue in patients with head and neck cancer receiving radical radiotherapy with curative intent. Patients and Methods Patients (N = 301) with hemoglobin ( Hb) less than 15 g/dL were randomly assigned in a ratio of 1: 1 to receive radiotherapy plus epoetin alfa ( 10,000 U subcutaneously [SC] three times weekly if baseline Hb was < 12.5 g/dL; 4,000 U SC three times weekly if baseline Hb >= 12.5 g/dL) or radiotherapy alone. Hb levels were monitored weekly. The primary end point was local DFS, defined as the time from random assignment to local disease recurrence or death. Secondary efficacy end points included OS, local tumor response, and local tumor control. Patients were followed at 1, 4, 8, and 12 weeks postradiotherapy and annually for 5 years. Cancer treatment related anemia and fatigue were evaluated with the Functional Assessment of Cancer Therapy-Anemia and Functional Assessment of Cancer Therapy-Head and Neck. Adverse events were recorded up to 12 weeks postradiotherapy. Results Hb levels increased from baseline with epoetin alfa. The median duration of local DFS was not statistically different between groups ( observation, 35.42 months; epoetin alfa, 31.47 months; hazard ratio, 1.04; 95% CI, 0.77 to 1.41). Groups did not significantly differ in DFS, OS, tumor outcomes, or cancer treatment-related anemia or fatigue. No new or unexpected adverse events were observed. Conclusion Addition of epoetin alfa to radical radiotherapy did not affect survival, tumor outcomes, anemia, or fatigue positively or negatively in patients with head and neck cancer.