Erythropoietin or Darbepoetin for patients with cancer

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

“…When this analysis was restricted to patients with Hb intervention levels of p11 g dl À1 in line with recent EORTC guidelines (Bokemeyer et al, 2007), the results showed a statistically significantly lower risk for disease progression in patients receiving epoetin-b. A similar finding of a more favourable outcome with respect to tumour progression in patients treated with ESA vs control was recently reported by the Cochrane Collaboration (Bohlius et al, 2006), as well as in a systematic review of 46 ESA trials conducted for the National Institute of Clinical Excellence (NICE) (Wilson et al, 2007). Whether the obvious discrepancy between outcomes of disease progression favouring epoetin treatment and survival outcomes favouring control/placebo treatment may be caused by an underdiagnosis of fatal TEEs (see section below) must remain speculative.…”

“…The results for overall survival are consistent with the findings from a recently updated meta-analysis of published, randomised clinical trials in patients with cancer receiving chemotherapy by the Cochrane Collaboration (Bohlius et al, 2006). A shift of the overall HR for mortality towards a more favourable outcome for patients in the control group compared to those receiving ESA treatment is different from the results of an earlier meta-analysis by the same group where a trend towards increased survival in patients treated with ESAs was shown (Bohlius et al, 2005).…”

“…Both studies had a number of methodologic limitations, including baseline imbalances and protocol violations, which confounded the interpretation (Leyland-Jones and Mahmud, 2004;Vaupel and Mayer, 2004). However, the results of an updated Cochrane metaanalysis by Bohlius et al (2006) of 57 trials including 9353 patients also found a shift of the HR for survival (HR ¼ 1.08; 95% CI: 0.99, 1.18; P ¼ 0.10) towards an increased risk for patients receiving various ESAs.…”

Epo and Non-hematopoietic Cells: What Do We Know?

“…Recent trials in which very high doses of Epo were administered to patients diagnosed with myocardial function showed an increased risk of thrombosis (176)(177)(178)(179). Thrombotic events were also increased in critical ill patients although Epo therapy significantly reduced mortality particularly in trauma patients (213), and increased risk of venous thromboembolism was also noted in cancer patients (214). Another trial provided evidence of a possible negative interaction between short-term administration of Epo and aspirin due to its ability to modulate endothelial activation and platelet reactivity, von Willebrand factor antigen levels and factor VIII activity (215,216).…”

Erythropoietic neuroprotection: Holy Grail or potential to fail?

“…Therefore, cEPO-FC may provide a cytoprotective capacity in the absence of the toxicity associated with systemic EPO therapy. The importance of this potential is emphasized by the paradoxical findings of recent clinical trials with rhEPO: (1) normalizing hematocrit with rhEPO does not necessarily improve survival; [12][13][14]; (2) high-dose rhEPO is associated with increased thrombosis [13,[15][16][17]; and (3) in some patient populations (trauma) low-dose rhEPO may improve survival without affecting hematocrit [18]. In addition, early clinical trials produced interesting results in relation to the treatment of stroke [7,11].…”