Cancer-related anemia and recombinant human erythropoietin—an updated overview

Abstract

For cancer patients, anemia can be a debilitating problem that negatively influences their overall quality of life and worsens their prognosis. The condition is caused either by the cancer itself or by cytotoxic treatment. Anemia is the primary indication for transfusion of red blood cells, but the development of recombinant human erythropoietins (epoetins) provides an alternative to red blood cell transfusions. Treatment with epoetins has been shown to reduce transfusion rates and increase hemoglobin response. There is some evidence that epoetins improve quality of life. It remains unclear, however, whether erythropoietin affects tumor growth and survival, and this area requires further investigation. Data from clinical trials suggest that erythropoietin increases the risk of thromboembolic complications. In the management of anemic patients, physicians should follow closely the dosing recommendations in products' package inserts or the ASCO/American Society of Hematology guidelines. Treatment of patients beyond the correction of anemia, however, has to be regarded as experimental and is potentially harmful, so should only be conducted in clinical trials.

Alternative Vascularization Mechanisms in Cancer

“…However, intratumoral hypoxia, responsible for chemo-and radiotherapy resistance and triggering molecular pathways that promote cancer progression, is due not only to the inefficient blood supply by the abnormal tumor vessels but to the systemic anemia of the host as well. 66 Unfortunately, although the oxygen tension of experimental tumors tends to rise with increasing Hb levels 67 and treatment with recombinant human erythropoietin (rHuEpo) significantly reduces the risk for red blood cell transfusions in cancer patients, correction of anemia with rHuEpo does not necessarily improve survival of cancer patients. 66 The issue of Epo/EpoR coexpression in tumor cells and EpoR expression in ECs is critical in this perspective.…”

“…66 Unfortunately, although the oxygen tension of experimental tumors tends to rise with increasing Hb levels 67 and treatment with recombinant human erythropoietin (rHuEpo) significantly reduces the risk for red blood cell transfusions in cancer patients, correction of anemia with rHuEpo does not necessarily improve survival of cancer patients. 66 The issue of Epo/EpoR coexpression in tumor cells and EpoR expression in ECs is critical in this perspective. The expression of EpoR in tumor cells has raised the possibility that exogenous rHuEPO may directly influence cancer cell proliferation, apoptosis, or sensitivity to chemoradiation therapy.…”

Management of anaemia in oncohaematological patients treated with biosimilar epoetin alfa: results of an Italian observational, retrospective study

“…Although considerable progress has been made in preventing or alleviating many of the common toxicities associated with cancer and its therapy, anaemia continues to be relatively undertreated [Loney et al 2000]. The efficacy of erythropoiesis-stimulating agents (ESAs) in correcting anaemia in cancer patients has been widely demonstrated [Littlewood et al 2003;Bohlius et al 2006]. These substances improve QoL and reduce the need for transfusion.…”

The Role Of Erythropoietin In The Treatment Of Anemia In Patients With Malignant Lymphoma

“…Anemia is a common complication of malignant lymphomas, which could be a direct consequence of the disease or secondary to the myelosupressive chemotherapy [1,2,3]. Th is may be due to the reduction of erythropoesis, manifested by reduction of erythrocyte half-life, poor iron reutilization by the bone marrow and inadequate response to erythropoetin with reduced endogenous erythropoetin levels [4,5,6].…”