Red blood cells carry oxygen throughout the body. If one has too few red blood cells, one will become anemic and feel tired and weak and lack energy most of the time. In cases of severe anemia, even mild exercise will result in fatique, difficulty in breathing and even chest pain. Severe anemia leaves the body weak and susceptible to many complications.
Red blood cells live for a month or two in the blood stream. They are slowly replaced by new red blood cells formed in the bone marrow. Chemotherapy generally attacks all rapidly dividing cells in the body and thus it has the side effect of lowering ones red cell count because no new red cells are generated for several days after chemotherapy. The lowering is not that dramatic, but since red blood cells are not generated that quickly, ones red blood cell count tends to drop with each chemotherapy treatment and not recover much between treatments. Thus one tends to become progressively more and more anemic with each chemotherapy cycle. The loss of energy caused by anemia makes it that much more difficult to emotionally tolerate chemotherapy. Typically, patients have their blood tested prior to each chemotherapy cycle. If red cell counts have dropped to too low a level, the next chemotherapy dose may be delayed or reduced, which is not a good thing from the point of view of fighting the disease. Alternatively, the patient may be forced to receive a blood transfusion, which carries with it other risks.
Epogen can be used to stimulate faster recovery to normal red cell levels, thus ensuring that the suffering due to anemia is minimized and that chemotherapy cycles can proceed normally, without delay or reduction due to low red cell counts. Since red cells take several weeks to mature, red cell counts may not increase until 2 weeks after starting Eprex and it may take up to 6 weeks of usage before red cell counts return to normal levels.
In Dulce's case, the initial use of Epogen was to strengthen her so that she could better tolerate an operation to restore a collapsed lung. We then continued with Epogen during each chemotherapy cycle to try to minimize her anemia as much as possible. Normally, Epogen is recommended to be used three times a week while chemotherapy is administered. For Dulce, such application seemed to stabilize her red counts so that while she remained slightly anemic, she did not become as severely anemic as she did before we began to use Epogen. This ensured that Dulce's red count was always close to normal when it came time for a subsequent chemotherapy treatment. While the short term effects of this drug are not dramatic, sustained usage seems to make a difference.
Epogen can be administered by intramuscular injection. This can be done by patients themselves as the needles required are basically the same as those used for insulin injection by diabetics. Such needles are available in most pharmacies. And any nurse or doctor can instruct a layperson how to do the injections. The Epogen vials need to be kept refrigerated. Epogen is quite expensive and not readily available in most pharmacies, but it can be ordered in. It is manufactured by several companies such as Amgen, Inc. and Ortho-Biotech, Inc. In 1998 it was not covered by British Columbia Pharmacare for general use during chemotherapy.
Several precautions are in order if considering Epogen. Since Epogen stimulates the bone marrow, it may cause the bone marrow to look abnormal during a bone scan or PET scan. Doctors are aware of this. One risk is that if a bone scan or PET scan show signs of cancer in the bones, then this may be dismissed as being due to the Epogen. Thus Epogen increases the likelihood of a false negative indication of bone cancer. Epogen may also cause flu-like symptoms and bone pain while it is being used, particularly at the start. Another precaution is that there has been speculation that Epogen, which is a simulating factor, might stimulate the cancer itself to spread to the bone marrow. Trials have not shown any indications that this happening, but it is a remote possibility. As in all cancer treatments, there are tradeoffs in risk to be made prior to proceeding with the treatment. I would suggest that all patients undergoing chemotherapy ensure that their doctors consider Epogen and have it available as an option should anemia occur. Kevin...
More information on Epogen® can be found at the web page of the manufacturers:
Amgen Inc.
Amgen Center
Thousand Oaks, CA 91320-1789
Tel: (805) 447-1000 Fax: (805) 447-1010
Web: www.amgen.com
Ortho-Biotech
North York
Ontario, Canada M3C 1L9
Web: www.procrit.com