Epoetin Alfa or Darbepoetin Alfa in Treating Patients With Anemia Caused by Chemotherapy
Condition: Anemia; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Precancerous Condition; Unspecified Adult Solid Tumor, Protocol Specific
MeSH terms: Lymphoma; Leukemia; Multiple Myeloma; Neoplasms, Plasma Cell; Plasmacytoma; Precancerous Conditions; Anemia; Lymphoproliferative Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      RATIONALE: Epoetin alfa and darbepoetin alfa may cause the body to make more red blood cells.
      They are used to treat anemia caused by chemotherapy in patients with cancer.

      PURPOSE: This randomized clinical trial is studying four different schedules of epoetin alfa
      or darbepoetin alfa to compare how well they work in treating patients with anemia caused by
      chemotherapy.
    

Detailed description: 
      OBJECTIVES:

      Primary

        -  Compare the relative efficacy of four different erythropoietic agent dosing schedules
           comprising epoetin alfa or darbepoetin alfa, in terms of the proportion of patients with
           chemotherapy-associated anemia who achieve a weekly and overall hematopoietic response.

      Secondary

        -  Compare the effect of these regimens on the mean hemoglobin increment measured weekly
           from baseline to 15 weeks in patients with a baseline hemoglobin of less than or equal
           to 10.5 g/dL.

        -  Compare the time required to achieve hemoglobin levels within the goal range 11.0-12.0
           g/dL in patients treated with these regimens.

        -  Compare the effect of these regimens on the proportion of patients requiring red blood
           cell transfusions and on the number of transfusions required.

        -  Compare the weekly change in hemoglobin in patients treated with these regimens.

        -  Compare the need for dose reduction in patients treated with these regimens.

        -  Compare the adverse event profiles of these regimens in these patients.

        -  Compare quality of life of patients treated with these regimens.

      OUTLINE: This is a randomized, unblinded, pilot study. Patients are stratified according to
      severity of anemia (mild [hemoglobin ≥ 9.5 g/dL] vs severe [hemoglobin < 9.5 g/dL]),
      platinum-containing regimen (yes vs no), and tumor type (nonmyeloid hematologic malignancy vs
      solid tumor). Patients are randomized to 1 of 4 treatment arms.

        -  Arm I: Patients receive epoetin alfa subcutaneously (SC) on day 1. Treatment repeats
           weekly for up to 15 courses in the absence of disease progression or unacceptable
           toxicity.

        -  Arm II: Patients receive epoetin alfa SC on day 1 (at a higher dose than in arm I).
           Treatment repeats every 3 weeks for up to 5 courses in the absence of disease
           progression or unacceptable toxicity.

        -  Arm III: Patients receive epoetin alfa SC on day 1 (at a higher dose than in arm II).
           Treatment repeats every 3 weeks for up to 5 courses in the absence of disease
           progression or unacceptable toxicity.

        -  Arm IV: Patients receive darbepoetin alfa SC on day 1. Treatment repeats every 3 weeks
           for up to 5 courses in the absence of disease progression or unacceptable toxicity.

      Hemoglobin levels are monitored throughout the study on a weekly basis and before each drug
      dose is administered. Drug dosing is adjusted (e.g., held, reduced, resumed at a lower dose)
      as needed to maintain hemoglobin values within the desired ranges.

      Quality of life is assessed at baseline and at weeks 4, 7, 10, 13, and 16.

      After completion of study treatment, patients are followed at 30 days.

      PROJECTED ACCRUAL: A total of 320 patients will be accrued for this study.
    

Intervention name(s): darbepoetin alfa; epoetin alfa; fatigue assessment and management; quality-of-life assessment
Intervention type(s): Drug; Drug; Procedure; Procedure
Intervention MeSH terms: Epoetin Alfa; Darbepoetin alfa
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: unspecified adult solid tumor, protocol specific; extramedullary plasmacytoma; isolated plasmacytoma of bone; refractory multiple myeloma; stage I multiple myeloma; stage II multiple myeloma; stage III multiple myeloma; Waldenstrom macroglobulinemia; post-transplant lymphoproliferative disorder; stage I adult T-cell leukemia/lymphoma; stage II adult T-cell leukemia/lymphoma; stage III adult T-cell leukemia/lymphoma; stage IV adult T-cell leukemia/lymphoma; recurrent adult T-cell leukemia/lymphoma; AIDS-related peripheral/systemic lymphoma; AIDS-related primary CNS lymphoma; angioimmunoblastic T-cell lymphoma; anaplastic large cell lymphoma; stage I cutaneous T-cell non-Hodgkin lymphoma; stage II cutaneous T-cell non-Hodgkin lymphoma; stage III cutaneous T-cell non-Hodgkin lymphoma; stage IV cutaneous T-cell non-Hodgkin lymphoma; recurrent cutaneous T-cell non-Hodgkin lymphoma; stage I mycosis fungoides/Sezary syndrome; stage II mycosis fungoides/Sezary syndrome; stage III mycosis fungoides/Sezary syndrome; stage IV mycosis fungoides/Sezary syndrome; recurrent mycosis fungoides/Sezary syndrome; stage I adult Hodgkin lymphoma; stage II adult Hodgkin lymphoma; stage III adult Hodgkin lymphoma; stage IV adult Hodgkin lymphoma; recurrent adult Hodgkin lymphoma; adult grade III lymphomatoid granulomatosis; stage I adult Burkitt lymphoma; stage III adult Burkitt lymphoma; stage IV adult Burkitt lymphoma; noncontiguous stage II adult Burkitt lymphoma; noncontiguous stage II adult diffuse large cell lymphoma; noncontiguous stage II adult diffuse mixed cell lymphoma; noncontiguous stage II adult diffuse small cleaved cell lymphoma; noncontiguous stage II adult immunoblastic large cell lymphoma; noncontiguous stage II adult lymphoblastic lymphoma; noncontiguous stage II grade 1 follicular lymphoma; noncontiguous stage II grade 2 follicular lymphoma; noncontiguous stage II grade 3 follicular lymphoma; noncontiguous stage II mantle cell lymphoma; noncontiguous stage II marginal zone lymphoma; noncontiguous stage II small lymphocytic lymphoma; contiguous stage II adult Burkitt lymphoma; contiguous stage II adult diffuse large cell lymphoma; contiguous stage II adult diffuse mixed cell lymphoma; contiguous stage II adult diffuse small cleaved cell lymphoma; contiguous stage II adult immunoblastic large cell lymphoma; contiguous stage II adult lymphoblastic lymphoma; contiguous stage II grade 1 follicular lymphoma; contiguous stage II grade 2 follicular lymphoma; contiguous stage II grade 3 follicular lymphoma; contiguous stage II mantle cell lymphoma; contiguous stage II marginal zone lymphoma; contiguous stage II small lymphocytic lymphoma; stage I adult diffuse large cell lymphoma; stage I adult diffuse mixed cell lymphoma; stage I adult diffuse small cleaved cell lymphoma; stage III adult diffuse large cell lymphoma; stage III adult diffuse mixed cell lymphoma; stage III adult diffuse small cleaved cell lymphoma; stage IV adult diffuse large cell lymphoma; stage IV adult diffuse mixed cell lymphoma; stage IV adult diffuse small cleaved cell lymphoma; stage I adult immunoblastic large cell lymphoma; stage III adult immunoblastic large cell lymphoma; stage IV adult immunoblastic large cell lymphoma; stage I adult lymphoblastic lymphoma; stage III adult lymphoblastic lymphoma; stage IV adult lymphoblastic lymphoma; stage I grade 1 follicular lymphoma; stage I grade 2 follicular lymphoma; stage I grade 3 follicular lymphoma; stage III grade 1 follicular lymphoma; stage III grade 2 follicular lymphoma; stage III grade 3 follicular lymphoma; stage IV grade 1 follicular lymphoma; stage IV grade 2 follicular lymphoma; stage IV grade 3 follicular lymphoma; stage I mantle cell lymphoma; stage I marginal zone lymphoma; stage III mantle cell lymphoma; stage III marginal zone lymphoma; stage IV mantle cell lymphoma; stage IV marginal zone lymphoma; stage I small lymphocytic lymphoma; stage III small lymphocytic lymphoma; stage IV small lymphocytic lymphoma; extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; nodal marginal zone B-cell lymphoma; splenic marginal zone lymphoma; recurrent adult Burkitt lymphoma; recurrent adult diffuse large cell lymphoma; recurrent adult diffuse mixed cell lymphoma; recurrent adult diffuse small cleaved cell lymphoma; recurrent adult grade III lymphomatoid granulomatosis; recurrent adult immunoblastic large cell lymphoma; recurrent adult lymphoblastic lymphoma; recurrent grade 1 follicular lymphoma; recurrent grade 2 follicular lymphoma; recurrent grade 3 follicular lymphoma; recurrent mantle cell lymphoma; recurrent marginal zone lymphoma; recurrent small lymphocytic lymphoma; adult acute lymphoblastic leukemia in remission; recurrent adult acute lymphoblastic leukemia; untreated adult acute lymphoblastic leukemia; stage I chronic lymphocytic leukemia; stage II chronic lymphocytic leukemia; stage III chronic lymphocytic leukemia; stage IV chronic lymphocytic leukemia; refractory chronic lymphocytic leukemia; refractory hairy cell leukemia; progressive hairy cell leukemia, initial treatment; prolymphocytic leukemia; anemia; monoclonal gammopathy of undetermined significance; primary systemic amyloidosis; T-cell large granular lymphocyte leukemia; acute undifferentiated leukemia; mast cell leukemia; adult nasal type extranodal NK/T-cell lymphoma; untreated hairy cell leukemia