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Petru, E; Stummvoll, W; Angleitner-Boubenizek, L; Scholl, T; Sevelda, P; Benedicic, C; Speiser, P; Reinthaller, A.
A Literature Review-Based Clinical Guide on the Use of Erythropoiesis-Stimulating Agents (ESA) in the Treatment of Patients with Gynaecological Malignancies and Related Anaemia
GEBURTSH FRAUENHEILK. 2010; 70(8): 646-657. Doi: 10.1055/s-0030-1250229
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Leading authors Med Uni Graz: Petru Edgar
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Abstract:: Purpose: Erythropoiesis-stimulating agents (ESA) are widely used in patients with chemotherapy-induced anaemia (CIA). They are efficacious in correcting haemoglobin status, reducing the need for red blood cell transfusions (RBCTs), and improving fatigue and quality of life. Reducing the need for RBCTs with ESAs is of particular importance, due to the significant associated risks including increased mortality. Although several benefits of ESA administration have been reported, their use is still a matter of debate. Nine clinical trials investigating patients with cancers of the breast, cervix, head and neck, non small cell lung cancer, and non-myeloid malignancies reported a negative impact of ESAs on survival. An analysis of these nine trials, however, revealed that in these studies the ESAs had not been administered according to the recommendations given in guidelines and approved indications (higher ESA doses than recommended; non-anaemic patients treated with ESAs; target Hb above the indicated level of 12 g/dl; radiotherapy without chemotherapy; no tumour-specific therapy). The broad "off-label" administration of ESAs seems to be the most likely reason for the observed adverse outcome in the cited trials. Two meta-analyses by Bennet 2008 [22] and Bohlius 2009 [23] were carried out in recent years. A subgroup analysis of these studies revealed no increased mortality in the ESA group when chemotherapy was administered concomitantly (HR 1.09 and HR 1.10, respectively; non-significant difference). Conclusion: ESAs should only be used in symptomatic oncology patients with Hb values < 10 g/dl undergoing chemotherapy. In these cases, no increased mortality is expected. Nevertheless, a significantly elevated risk for venous thromboembolisms has to be taken into account when considering ESA therapy.
Find related publications in this database (Keywords): erythropoiesis stimulating agents; erythropoietin; tumour-related anaemia; chemotherapy; breast cancer