Effect of treatment with epoetin-β on survival, tumour progression and thromboembolic events in patients with cancer: an updated meta-analysis of 12 randomised controlled studies including 2301 patients

Abstract

Epoetin-b is used to treat patients with metastatic cancer undergoing chemotherapy to alleviate the symptoms of anaemia, reduce the risk of blood transfusions and improve quality of life. This meta-analysis of 12 randomised, controlled studies evaluated the impact of epoetin-b on overall survival, tumour progression and thromboembolic events (TEEs). A total of 2297 patients were included in the analysis (epoetin-b, n ¼ 1244; control, n ¼ 1053; 65% solid and 35% nonmyeloid haematological malignancies). A prespecified subgroup analysis assessed the effects in patients with a baseline Hbp11 g dl À1 , corresponding to current European Organisation for Research and Treatment of Cancer (EORTC) guidelines. No statistically significant effect on mortality was observed with epoetin-b vs control, both overall (hazard ratio (HR) ¼ 1.13; 95% CI: 0.87, 1.46; P ¼ 0.355) and in patients with baseline Hbp11 g dl À1 (HR ¼ 1.09; 95% CI: 0.80, 1.47; P ¼ 0.579). A trend for a beneficial effect on tumour progression was seen overall (HR ¼ 0.85; 95% CI: 0.72, 1.01; P ¼ 0.072) and in patients with an Hbp11 g dl À1 (HR ¼ 0.80; 95% CI: 0.65, 0.99; P ¼ 0.041). An increased frequency of TEEs was seen with epoetin-b vs control (7 vs 4% of patients); however, TEEs-related mortality was similar in both groups (1% each). The results of this meta-analysis indicate that when used within current EORTC treatment guidelines, epoetin-b has no negative impact on survival, tumour progression or TEEs-related mortality.

Early Venous Thromboembolic Events Are Associated With Worse Prognosis in Patients With Lung Cancer

“…ECOG performance status (PS) was considered as a dichotomous variable (> 2 or ≤ 2), since there was not always enough clinical information available in the charts to classify patients with a PS ≤ 2 further. Medication use thought to be associated with a higher risk of VTE was also abstracted and included: erythropoietin stimulating agents (ESA) [13], estrogen and progestin containing medications [14], tamoxifen [15] and bevacizumab [16]. Overall survival follow-up was complete for all patients.…”

Epoetin-β treatment in patients with cancer chemotherapy-induced anaemia: the impact of initial haemoglobin and target haemoglobin levels on survival, tumour progression and thromboembolic events

“…In the four studies with longterm follow-up data, when all events were included, median follow up was also comparable (28.8 months with epoetin-b and 29.8 months with control) (Aapro et al, 2008a). …”

“…Baseline characteristics of the patients in the analysis are described in the earlier publication (Aapro et al, 2008a) and are shown in Table 2. Of the 2297 patients in the analysis, 35% had non-myeloid haematological malignancies (mainly non-Hodgkin's lymphoma or multiple myeloma) and 65% had solid tumours (most commonly primary malignancies of the breast, head and neck, colon/rectum and ovary).…”

“…The results of this metaanalysis based on individual patient level data showed no statistically significant difference between patients receiving epoetin-b or control (standard treatment) in terms of overall survival, a favourable trend with respect to the risk of disease progression for patients receiving epoetin-b and a higher risk of thromboembolic events associated with epoetin-b treatment (Aapro et al, 2008a). Recently, the Cochrane Collaboration has published an updated meta-analysis, which includes data on epoetin-a, epoetin-b and darbepoetin from 53 randomized, controlled studies in cancer patients.…”

“…We previously reported results of an updated meta-analysis of 12 randomised, controlled studies of epoetin-b conducted in 2301 patients undergoing cancer therapy (Aapro et al, 2008a) including three recently completed trials with longer term follow-up in patients with head and neck cancer (Henke et al, 2003), patients with metastatic breast cancer (Aapro et al, 2008b) and patients with cervical cancer (Strauss et al, 2008). The results of this metaanalysis based on individual patient level data showed no statistically significant difference between patients receiving epoetin-b or control (standard treatment) in terms of overall survival, a favourable trend with respect to the risk of disease progression for patients receiving epoetin-b and a higher risk of thromboembolic events associated with epoetin-b treatment (Aapro et al, 2008a).…”