• Number of red blood cell transfusions
  

• Hemoglobin levels during preoperative chemoradiation; effect on quality of life measured by patient self-reported Linear Analog Scale Assessment, Functional Assessment of Cancer Therapy-Anemia, and Brief Fatigue Inventory; tumor response; safety
  

Cancer patients often experience anemia due to the disease itself, chemotherapy, or both. Quality of life is also affected, in part because of the fatigue associated with anemia. Previous studies with epoetin alfa have suggested that achieving a higher hemoglobin level may improve quality of life and help patients live longer. The primary objective of the study is to demonstrate the effectiveness and safety of epoetin alfa on the reduction in red blood cell transfusions needed in gastric and rectal cancer patients undergoing preoperative chemotherapy and radiation therapy (chemoradiation), followed by surgery. The purpose of this study is to assess the effectiveness of 40,000 to 60,000 Units of epoetin alfa or matching placebo injected under the skin once weekly for up to 16 weeks (starting 1 week before chemoradiation and extending up to 4 weeks after surgery) in reducing red blood cell transfusions during the 16-week period. Other effectiveness measures include the ability of epoetin alfa to maintain baseline hemoglobin levels during the chemoradiation and its effect on quality of life and tumor response during the study period. The safety of epoetin alfa will be assessed by incidence and severity of adverse events, clinical laboratory tests, physical examinations, and vital signs. The hypothesis of the study is that epoetin alfa is superior to placebo in reducing the number of transfusions, preventing anemia and improving quality of life during chemoradiation, surgery, and immediately after surgery. 40,000 to 60,000 Units of epoetin alfa or placebo injected under the skin once weekly for up to 16 weeks. First 4 weeks the dose is 40,000 Units; increased to 60,000 Units weekly starting at week 4 of chemoradiation if hemoglobin decreases by >=1 g/dL and/or is <=13 g/dL after 4 weeks of treatment.