Cost analysis of erythropoietin versus blood transfusions for cervical cancer patients receiving chemoradiotherapy.

PURPOSE: Red blood cell (RBC) transfusions or erythropoietin (EPO) can be used to evade the detrimental effects of anemia during radiotherapy, but the economic consequences of selecting either intervention are not well defined. The RBC transfusion needs during chemoradiotherapy for cervix cancer were quantified to allow comparison of RBC transfusion costs with the projected cost of EPO in this setting. METHODS AND MATERIALS: For patients receiving pelvic radiotherapy, weekly cisplatin, and brachytherapy, the RBC units transfused during treatment were tallied. RBC transfusion costs per unit included the blood itself, laboratory fees, and expected value (risk multiplied by cost) of transfusion-related viral illness. EPO costs included the drug itself and supplemental RBC transfusions when hemoglobin was not adequately maintained. An EPO dosage based on reported usage in cervix cancer patients was applied. RESULTS: Transfusions were given for hemoglobin <10 g/dL. Among 12 consecutive patients, 10 needed at least 1 U of RBC before or during treatment, most commonly after the fifth week. A total of 37 U was given during treatment, for an average of 3.1 U/patient. The sum total of the projected average transfusion-related costs was $990, compared with the total projected EPO-related costs of $3869. CONCLUSIONS: Because no proven clinical advantage has been documented for EPO compared with RBC transfusions to maintain hemoglobin during cervix cancer treatment, for most patients, transfusions are an appropriate and appealingly less expensive option.

Pegylated liposomal doxorubicin: tolerability and toxicity.

We evaluated the tolerability and toxicity attributed to pegylated liposomal doxorubicin (PL-DOX) in women with recurrent or refractory ovarian cancer, and reviewed procedures to prevent or treat toxicity induced by the agent. Medical records of 13 women who received PL-DOX between October 1997 and December 2000 were reviewed. Patients 1-8 received PL-DOX once it was added to the hospital formulary in 1997. Patients 9-13 received it after medical staff education. Data on premedications, number of cycles, dosage, length of infusion, tolerability, side effects, and indicators for response were collected. The median number of cycles and cumulative dose/patient of PL-DOX were higher (6 and 420 mg) in the second group than in the first group (2 and 240 mg). Patient factors such as duration of disease and number of chemotherapy cycles influenced tolerability. One patient experienced a life-threatening adverse reaction within minutes of receiving the first dose. Treatment was discontinued, and she was resuscitated successfully. Other dose- or treatment-limiting complications (neutropenia, stomatitis, plantar-palmar erythrodysesthesia) were documented. Toxicity management consisted of dosage reduction or treatment delay; treatment often was discontinued. Patients with recent disease tolerated more cycles of PL-DOX when given early in recurrence compared with heavily pretreated women with long-standing disease. Tolerability was not necessarily indicative of response. The agent is simple to administer, but its tolerability and lack of uniform toxicity management remain concerns.

Validation of a limited sampling model to determine etoposide area under the curve.

STUDY OBJECTIVE: To validate the utility of a previously reported 3-point limited sampling model (LSM) for determining etoposide area under the curve to infinity (AUC(infinity)). DESIGN: Secondary analysis of data from two clinical trials of etoposide. SETTING: University medical center clinical research center. PATIENTS: Thirty-four patients with different malignancies. INTERVENTIONS: Etoposide was administered as a 2-hour infusion to 34 patients. Serial plasma samples were drawn over 24 hours after the infusion and analyzed for etoposide by high-performance liquid chromatography. MEASUREMENTS AND MAIN RESULTS: The 3-point LSM AUC was compared with a 14-point actual AUC calculated by the linear trapezoidal rule. Actual and predicted AUC(infinity) by the LSM were highly correlated (r=0.97, p<0.0001). The LSM predictions had a mean absolute error of 10.9% (95% CI -14.1, -5.3) and a mean error of -9.7% (95% CI 6.9, 14.9). Nine patients with poor AUC(infinity) estimations by the LSM (error > 12%) tended to have abnormally low or high peak concentrations. CONCLUSION: Our findings suggest the development of more robust LSM using other techniques, such as pharmacostatistical models, that can accommodate a greater degree of pharmacokinetic variability.