Treatment of Chemotherapy-Induced Anemia Using Epoetin Alfa Biosimilar for Patients with Lymphoma and Myeloma: The Synergy Study
Authors: Scotté Florian , Laribi Kamel , Gisselbrecht Christian , Spaeth Dominique , Kasdaghli Emna , Albrand Hélène , Leutenegger Eric , Ray-Coquard Isabelle 
Published: October 2019

Background
Recommendations on erythropoiesis-stimulating agents for the management of chemotherapy-induced anemia (CIA) are well established (Schrijvers D et al. Ann Oncol 2010;21[suppl 5]:v244-7). Iron supplementation can further improve treatment response of CIA, particularly in the case of iron deficiency (Pedrazzoli P et al. J Clin Oncol 2008;26:1619-25; Auerbach M et al. J Clin Oncol 2004;22:1301-7), but is under-used.
Objective
To evaluate the effect of epoetin alfa biosimilar, with or without iron, on CIA in current oncology and hematology practice.
Methods
SYNERGY was an observational, longitudinal, prospective, multicenter study conducted in France, from a representative, random sample of oncologists and hematologists. Patients of these clinicians were aged ≥18 years with solid tumors, lymphoma and/or myeloma and CIA, eligible for treatment with epoetin alfa biosimilar and followed for 12-16 weeks. A subanalysis of patients with lymphoma or multiple myeloma is presented here.
Results
Overall, 2167 patients were enrolled by 195 French oncologists and hematologists during June 2012-December 2014. Of these patients, 12.7% (n=264) had lymphoma and 6.6% (n=136) had multiple myeloma and were included in the analysis population, where the disease categories were non-exclusive; 84.5% (n=223) of patients with lymphoma were diagnosed with non-Hodgkin's lymphoma. Half of the patients with lymphoma and multiple myeloma were male. The majority of patients were ≥70 years old (60.6% of patients with lymphoma and 69.1% with multiple myeloma) and had a performance status of 0 or 1 (72.9% [n=180] of patients with lymphoma and 71.8% [n=94] with multiple myeloma). Baseline mean ± standard deviation (SD) hemoglobin (Hb) levels of patients with lymphoma and multiple myeloma were 9.5±0.8 g/dL and 9.5±0.9 g/dL; 40.2% (n=106) and 39.0% (n=53) of these patients had moderate anemia (Hb 8.0-9.5 g/dL), while 2.3% (n=6) and 4.4% (n=6) had severe or very severe anemia (Hb ≤8.0 g/dL), respectively. Iron status assessment was available for 60.2% (n=159) of patients with lymphoma and for 59.6% (n=81) with multiple myeloma. Concomitant iron supplementation was not prescribed with epoetin alfa biosimilar for the majority of patients. A total of 11.4% (n=30) of patients with lymphoma and 6.6% (n=9) of patients with multiple myeloma received iron, of whom 63.3% (n=19) and 77.8% (n=7) were prescribed oral iron formulations, respectively.
Patients who reached their target Hb level (increase of ≥1 g/dL since enrollment or an increase of ≥2 g/dL, with no transfusions in the three previous weeks) was 79.1% (n=201) of patients with lymphoma and 84.6% (n=104) of patients with multiple myeloma, higher than the overall analyzed population (74.2%, n=1390). The response rate to epoetin alfa biosimilar (epoetin alfa biosimilar discontinued as Hb > target level, with no transfusions in the three previous weeks) was lower in patients with lymphoma given iron supplementation versus those not given iron; 66.7% (n=20) of the iron supplementation group were responders, compared with 75.4% (n=169) of patients without iron. Response to epoetin alfa biosimilar was similar in patients with multiple myeloma regardless of the iron supplementation status (85.7% [n=6] of patients with iron supplementation and 81.0% [n=94] of patients without). The response to epoetin alfa biosimilar translated into an improvement in patient perception of fatigue (66.7% [n=20] of patients with iron supplementation and 72.5% [n=161] of patients without who had lymphoma; 71.4% [n=5] of patients with iron supplementation and 81.3% [n=91] of patients without who had multiple myeloma).
Conclusions
These results indicate that epoetin alfa biosimilar was effective in treating patients with CIA and lymphoma/myeloma in France and agrees with previous studies (Michallet M et al. BMC Cancer 2014;14:503). Iron supplementation did not appear to increase the response to epoetin alfa treatment in this population; however, confirmatory studies in larger patient cohorts are required.

Disclosures
Scotté: Hospira SAS: Research Funding. Laribi:Hospira SAS: Research Funding. Gisselbrecht:Hospira SAS: Research Funding; Roche: Consultancy, Research Funding; Baxter: Research Funding; Chugai Pharmaceutical: Research Funding; Bertram Glass: Research Funding. Spaeth:Hospira SAS: Research Funding. Kasdaghli:Hospira: Employment. Albrand:Hospira: Employment. Leutenegger:GECEM: Employment; Hospira SAS: Research Funding. Ray-Coquard:Hospira SAS: Research Funding; Amgen: Consultancy, Other: Paid instructor; PharmaMar: Consultancy, Other: Paid instructor; Roche: Consultancy, Other: Paid instructor.