The effect of subcutaneous recombinant human erythropoietin (r-HuEPO) on anemia in cancer patients receiving platinum-based chemotherapy.

Advanced cancer is commonly associated with significant anemia which worsens with the administration of cytotoxic drugs. Erythropoietin (EPO) levels in these patients are usually inappropriately low for the degree of anemia. We evaluated the effect of subcutaneous administration of recombinant human erythropoietin (r-HuEPO) on hematologic parameters and transfusion requirements in anemic cancer patients who were receiving platinum-based chemotherapy. Baseline studies included complete hemogram, reticulocyte count, serum iron, TIBC, ferritin and determination of performance status and quality of life (QOL). Twenty-three patients, 13 females, 10 males with mean age 52 years received 150 units/kg of r-HuEPO three times weekly for a minimum of 10 weeks. They also received supplemental iron. Ovarian cancer was the commonest underlying malignancy. Most of the patients received platinum-based combination chemotherapy. Mean duration of r-HuEPO therapy was 12.6 weeks. Average baseline reticulocyte count was 1.8% which increased to 7.0% after one week therapy. Eight patients had normalization of hemoglobin values. Another eight patients improved their hemoglobin by at least 2 g/dl, however, hemoglobin values remained below the normal range. Two patients had only slight increase in hemoglobin but never required blood transfusion. Three patients who were transfusion dependent had decrease in the transfusion requirements. Two patients had no significant benefit. In most patients response was evident within 2 weeks. All responders had improvement in QOL. No significant toxicity was observed. We conclude that r-HuEPO, given subcutaneously, is highly effective in amelioration of anemia and prevention of or reduction in transfusion requirements in cancer patients receiving platinum-based chemotherapy.

Nutritional aspects of mammary carcinogenesis: a case-control study.

Dietary factors are believed to play an important role in mammary carcinogenesis. International correlations, case-control and cohort studies have associated the incidence and mortality from breast cancer with high fat consumption in the form of meat, gravy and dairy products. Most of these studies have been conducted in the developed countries. Due to paucity of data from developing countries, we conducted a case-control study to evaluate the role of nutritional factors in mammary carcinogenesis. This prospective study was conducted in the oncology clinic at a university hospital. On a detailed questionnaire, information was collected from 80 patients with histologically proven breast cancer (cases) and 80 normal healthy subjects (controls). Information was collected on several patients characteristics as well as intake of 44 different food items. Special care was taken to exclude any recent changes in diet, induced in cases since learning the diagnosis of breast cancer. Interviews were conducted by the same interviewer and lasted approximately 20 minutes. Analysis of data reveal no significant difference in patients characteristics between cases and controls. Similarly, no significant difference was found in the intake of most dietary items including meat and dairy products. However, a significant difference was observed in the consumption of fish, vegetable and fruits (P = 0.05). We conclude that our study fails to support the fat-breast cancer hypothesis. It also suggests a potential role of other dietary items such as fish, vegetables and fruits in mammary carcinogenesis.