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Effect of Epoetin on Survival in Patients With Breast Cancer

Giovanni Codacci-Pisanelli, Gian Paolo Spinelli, Silverio Tomao

Department of Experimental Medicine, University of Rome Sapienza, Rome, Italy

To the Editor:

We read with great interest the paper by Aapro et al¹ on the survival of breast cancer patients treated with erythropoietin in comparison with untreated patients. The authors conclude that, at 18 months, there is no difference in survival (both overall and progression free). According to our opinion, the results of the study should be interpreted with caution; in fact, the patients received subcutaneous epoetin beta 30,000 U once weekly for 24 weeks (6 months). A previous study in a similar setting reported a better survival for patients not receiving erythropoietin.² In this study patients were randomly assigned to receive epoetin alfa 40,000 U subcutaneously once weekly or placebo for 12 months. A difference in mortality was observed by the first 4 months of therapy: 8.7% early deaths in epoetin group versus 3.4% in the placebo group. In this case, data were analyzed at 16 weeks.² We would like to ask Aapro et al to analyze survival data at a similar time point, at the end of erythropoietin treatment. According to their Figure 1, it appears that survival curves are, in fact, at a different level, and control patients seem to do better than treated patients.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

NOTES

published online ahead of print at www.jco.org on April 28, 2008

REFERENCES

1. Aapro M, Robert C, Leonard AB, et al: Effect of once-weekly epoetin beta on survival in patients with metastatic breast cancer receiving anthracycline- and/or taxane-based chemotherapy: Results of the Breast Cancer-Anemia and the Value of Erythropoietin (BRAVE) study. J Clin Oncol 26:592-598, 2008[Abstract/Free Full Text]

2. Leyland-Jones B, Semiglazov V, Pawlicki M, et al: Maintaining normal hemoglobin levels with epoetin alfa in mainly nonanemic patients with metastatic breast cancer receiving first-line chemotherapy: A survival study. J Clin Oncol 23:5960-5972, 2005[Abstract/Free Full Text]

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