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memo - Magazine of European Medical Oncology
Published in: memo - Magazine of European Medical Oncology 4/2023

Open Access 28-08-2023 | Erythropoietin | short review

Erythropoiesis-stimulating agents—benefits and harms in the treatment of anemia in cancer patients

Authors: Ronald Heregger, Univ.-Prof. Dr. Richard Greil

Published in: memo - Magazine of European Medical Oncology | Issue 4/2023

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Summary

Anemia is a common finding in patients with solid or hematological malignancies. The underlying causes of cancer-related anemia can be multifactorial, including toxicity of cancer therapy, raised inflammatory conditions by the cancer, chronic bleeding and malnutrition. Therapeutic approaches for the treatment of chemotherapy induced anemia encompass red blood cell (RBC) transfusions and erythropoietin-stimulating agents (ESAs). The latter are approved for the treatment of patients with symptomatic anemia caused by palliative chemotherapy to reduce the number of RBC transfusions and gradually improve anemia-related symptoms. Before the treatment with ESA, a baseline Hb level < 10 g/dl is mandatory and iron deficiency must be ruled out. ESAs are linked to an increase in thromboembolic events and potentially raised mortality. Therefore, the risk-benefit ratio should be carefully assessed.
Literature
1.
Ludwig H, Van Belle S, Barrett-Lee P, Birgegård G, Bokemeyer C, Gascón P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40(15):2293–306.CrossRefPubMed
2.
Bohlius J, Bohlke K, Castelli R, Djulbegovic B, Lustberg MB, Martino M, et al. Management of cancer-associated anemia with erythropoiesis-stimulating agents: aSCO/ASH clinical practice guideline update. J Clin Oncol. 2019;37(15):1336–51.CrossRefPubMed
3.
Aapro M, Beguin Y, Bokemeyer C, Dicato M, Gascón P, Glaspy J, et al. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines〈sup〉&#x2020;〈/sup〉. Ann Oncol. 2018;29:iv96:iv110.
4.
Hellström-Lindberg E, Gulbrandsen N, Lindberg G, Ahlgren T, Dahl IM, Dybedal I, et al. A validated decision model for treating the anaemia of myelodysplastic syndromes with erythropoietin + granulocyte colony-stimulating factor: significant effects on quality of life. Br J Haematol. 2003;120(6):1037–46.CrossRefPubMed
5.
Littlewood TJ, Zagari M, Pallister C, Perkins A. Baseline and early treatment factors are not clinically useful for predicting individual response to erythropoietin in anemic cancer patients. The Oncol. 2003;8(1):99–107.CrossRef
6.
Sekeres MA, Fu AZ, Maciejewski JP, Golshayan AR, Kalaycio ME, Kattan MW. A Decision analysis to determine the appropriate treatment for low-risk myelodysplastic syndromes. Cancer. 2007;109(6):1125–32.CrossRefPubMed
7.
Park S, Grabar S, Kelaidi C, Beyne-Rauzy O, Picard F, Bardet V, et al. Predictive factors of response and survival in myelodysplastic syndrome treated with erythropoietin and G‑CSF: the GFM experience. Blood. 2008;111(2):574–82.CrossRefPubMed
8.
Mundle S, Lefebvre P, Vekeman F, Duh MS, Rastogi R, Moyo V. An assessment of erythroid response to epoetin alpha as a single agent versus in combination with granulocyte- or granulocyte-macrophage-colony-stimulating factor in myelodysplastic syndromes using a meta-analysis approach. Cancer. 2009;115(4):706–15.CrossRefPubMed
9.
Tonia T, Mettler A, Robert N, Schwarzer G, Seidenfeld J, Weingart O, et al. Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev. 2012;12(12):Cd3407.PubMed
10.
Fujisaka Y, Sugiyama T, Saito H, Nagase S, Kudoh S, Endo M, et al. Randomised, phase III trial of epoetin‑β to treat chemotherapy-induced anaemia according to the EU regulation. Br J Cancer. 2011;105(9):1267–72.CrossRefPubMedPubMedCentral
11.
Cella D, Eton DT, Lai JS, Peterman AH, Merkel DE. Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage. 2002;24(6):547–61.CrossRefPubMed
12.
Bohlius J, Tonia T, Nüesch E, Jüni P, Fey MF, Egger M, et al. Effects of erythropoiesis-stimulating agents on fatigue- and anaemia-related symptoms in cancer patients: systematic review and meta-analyses of published and unpublished data. Br J Cancer. 2014;111(1):33–45.CrossRefPubMedPubMedCentral
13.
Chang J, Couture F, Young S, McWatters KL, Lau CY. Weekly epoetin alfa maintains hemoglobin, improves quality of life, and reduces transfusion in breast cancer patients receiving chemotherapy. J Clin Oncol. 2005;23(12):2597–605.CrossRefPubMed
14.
Pronzato P, Cortesi E, van der Rijt CC, Bols A, Moreno-Nogueira JA, de Oliveira CF, et al. Epoetin alfa improves anemia and anemia-related, patient-reported outcomes in patients with breast cancer receiving myelotoxic chemotherapy: results of a European, multicenter, randomized, controlled trial. The Oncol. 2010;15(9):935–43.CrossRef
15.
Bennett CL, Silver SM, Djulbegovic B, Samaras AT, Blau CA, Gleason KJ, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA. 2008;299(8):914–24.CrossRefPubMed
16.
Gao S, Ma JJ, Lu C. Venous thromboembolism risk and erythropoiesis-stimulating agents for the treatment of cancer-associated anemia: a meta-analysis. Tumour Biol. 2014;35(1):603–13.CrossRefPubMed
17.
Aapro M, Scherhag A, Burger HU. Effect of treatment with epoetin-beta on survival, tumour progression and thromboembolic events in patients with cancer: an updated meta-analysis of 12 randomised controlled studies including 2301 patients. Br J Cancer. 2008;99(1):14–22.CrossRefPubMedPubMedCentral
18.
Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J, et al. Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials. Lancet. 2009;373(9674):1532–42.CrossRefPubMed
19.
Wright JR, Ung YC, Julian JA, Pritchard KI, Whelan TJ, Smith C, et al. Randomized, double-blind, placebo-controlled trial of erythropoietin in non-small-cell lung cancer with disease-related anemia. J Clin Oncol. 2007;25(9):1027–32.CrossRefPubMed
20.
Leyland-Jones B, Semiglazov V, Pawlicki M, Pienkowski T, Tjulandin S, Manikhas G, 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. 2005;23(25):5960–72.CrossRefPubMed
21.
Glaspy J, Crawford J, Vansteenkiste J, Henry D, Rao S, Bowers P, et al. Erythropoiesis-stimulating agents in oncology: a study-level meta-analysis of survival and other safety outcomes. Br J Cancer. 2010;102(2):301–15.CrossRefPubMedPubMedCentral
22.
Tonelli M, Hemmelgarn B, Reiman T, Manns B, Reaume MN, Lloyd A, et al. Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis. CMAJ. 2009;180(11):E62–71.CrossRefPubMedPubMedCentral
23.
Henke M, Laszig R, Rübe C, Schäfer U, Haase KD, Schilcher B, et al. Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial. Lancet. 2003;362(9392):1255–60.CrossRefPubMed
24.
Thomas G, Ali S, Hoebers FJ, Darcy KM, Rodgers WH, Patel M, et al. Phase III trial to evaluate the efficacy of maintaining hemoglobin levels above 12.0 g/dL with erythropoietin vs above 10.0 g/dL without erythropoietin in anemic patients receiving concurrent radiation and cisplatin for cervical cancer. Gynecol Oncol. 2008;108(2):317–25.CrossRefPubMed
25.
Shenouda G, Zhang Q, Ang KK, Machtay M, Parliament MB, Hershock D, et al. Long-term results of radiation therapy oncology group 9903: a randomized phase 3 trial to assess the effect of erythropoietin on local-regional control in anemic patients treated with radiation therapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2015;91(5):907–15.CrossRefPubMedPubMedCentral
26.
Leyland-Jones B, Bondarenko I, Nemsadze G, Smirnov V, Litvin I, Kokhreidze I, et al. A Randomized, Open-Label, Multicenter, Phase III Study of Epoetin Alfa Versus Best Standard of Care in Anemic Patients With Metastatic Breast Cancer Receiving Standard Chemotherapy. J Clin Oncol. 2016;34(11):1197–207.CrossRefPubMed
27.
Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355(20):2085–98.CrossRefPubMed
28.
29.
Grant MD, Piper M, Bohlius J, Tonia T, Robert N, Vats V, et al. AHRQ comparative effectiveness reviews. Epoetin and Darbepoetin for managing anemia in patients undergoing cancer treatment: comparative effectiveness update. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013.
30.
Aapro M, Osterwalder B, Scherhag A, Burger HU. Epoetin-beta treatment in patients with cancer chemotherapy-induced anaemia: the impact of initial haemoglobin and target haemoglobin levels on survival, tumour progression and thromboembolic events. Br J Cancer. 2009;101(12):1961–71.CrossRefPubMedPubMedCentral
Metadata
Title
Erythropoiesis-stimulating agents—benefits and harms in the treatment of anemia in cancer patients
Authors
Ronald Heregger
Univ.-Prof. Dr. Richard Greil
Publication date
28-08-2023
Publisher
Springer Vienna
Published in
memo - Magazine of European Medical Oncology / Issue 4/2023
Print ISSN: 1865-5041
Electronic ISSN: 1865-5076
DOI
https://doi.org/10.1007/s12254-023-00902-4

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