Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx

Gläser, Christian; Millesi, W.; Kornek, Gabriela; Lang, Susanna; Schüll, Birgit; Watzinger, Franz; Selzer, Edgar; Lavey, Robert S.

doi:10.1016/s0360-3016(01)01488-2

Cited by 243 publications

(120 citation statements)

References 48 publications

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“…In a non-randomised study of 191 patients undergoing neoadjuvant chemoradiotherapy and resection for squamous cell carcinoma of the oral cavity or oropharynx, treatment with epoetin was associated with significantly better local control and survival compared with an untreated historical control group (Glaser et al, 2001). Similarly, in a preliminary report, treatment with epoetin improved tumour control and survival in a randomised controlled trial of 385 patients with various pelvic malignancies receiving radiotherapy (Antonadou et al, 2001).…”

Section: Discussionmentioning

confidence: 94%

“…Preclinical data have indicated that administration of epoetin can enhance response to therapy and delay tumour progression (Mittelman et al, 2001;Thews et al, 2001;Stuben et al, 2003), whereas early clinical studies have suggested a potential survival benefit associated with epoetin in patients receiving radiotherapy and/or chemotherapy (Antonadou et al, 2001;Glaser et al, 2001;Littlewood et al, 2001). This hypothesis is supported by results of a meta-analysis of randomised controlled trials that reported a trend towards increased survival in patients treated with erythropoietic agents (Bohlius et al, 2005).…”

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confidence: 99%

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Effect of treatment with epoetin beta on short-term tumour progression and survival in anaemic patients with cancer: a meta-analysis

et al. 2006

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To assess the early effect of epoetin beta on survival and tumour progression in anaemic patients with cancer, data were pooled from nine randomised clinical trials comparing epoetin beta with placebo or standard care. Studies were not primarily designed to assess these end points. Follow-up was for treatment duration plus 4 weeks following therapy completion. All adverse events (AEs) were retrospectively reviewed blinded, for progression. Thromboembolic events were also assessed. Data analysis involved standard statistical tests. Overall, 1413 patients were included (epoetin beta, n ¼ 800; control, n ¼ 613; 56% haematological, and 44% solid). Median initial epoetin beta dose was 30 000 IU/week. Overall survival during months 0 -6 was similar with epoetin beta and control (0.31 vs 0.32 deaths/patient-year). No increased mortality risk was seen with epoetin beta (relative risk (RR) 0.97, 95% CI: 0.69, 1.36; P ¼ 0.87). There was a significantly reduced risk of rapidly progressive disease for epoetin beta (RR 0.78, 95% CI: 0.62, 0.99; P ¼ 0.042). Epoetin beta was associated with a slightly higher frequency of thromboembolic events vs control (5.9% vs 4.2% of patients) but thromboembolic-related mortality was identical in both groups (1.1%). Epoetin beta provided a slight beneficial effect on tumour progression and did not impact on early survival or thromboembolic-related mortality.

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Section: Discussionmentioning

confidence: 94%

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confidence: 99%

Effect of treatment with epoetin beta on short-term tumour progression and survival in anaemic patients with cancer: a meta-analysis

et al. 2006

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“…Moreover, in clinical studies, a potential survival benefit has been shown in patients undergoing cancer therapy who received treatment with ESAs (Antonadou et al, 2001;Glaser et al, 2001;Littlewood et al, 2001). The results of the first meta-analysis of 19 randomised, controlled trials in 2865 cancer patients receiving ESAs, reported by the Cochrane Group, showed a trend towards increased survival in patients treated with ESAs (hazard ratio (HR) ¼ 0.81; 95% CI: 0.67, 0.99; P ¼ 0.04) and lent support to these findings (Bohlius et al, 2005).…”

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confidence: 99%

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

2008

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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.

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“…Haemoglobin concentration has been shown to be an important predictive factor for the outcome of radiotherapy or chemoradiotherapy in the treatment of various types of cancer, including uterine -cervix cancer (Fyles et al, 1998), head and neck cancer (Glaser et al, 2001) and bronchogenic carcinoma (Kovacs et al 1998). Data on the predictive role of Hb on disease response to chemotherapy are lacking.…”

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confidence: 99%

Pretreatment haemoglobin levels significantly predict the tumour response to primary chemotherapy in human breast cancer

et al. 2003

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The purpose of this study was to evaluate whether tumour response to primary chemotherapy in human breast cancer is influenced by baseline haemoglobin (Hb) status. A total of 157 patients with T2-4, N0-1 M0 breast cancer were treated with chemotherapy consisting of either the CMF regimen þ tamoxifen (the first 76 cases) or the single-agent epirubicin (the subsequent 81) before definitive surgery. In total, 144 patients were fully assessable. Ki67, p53, bcl-2, c-erbB2, steroid hormone receptor, and microvessel density were evaluated immunohistochemically in tumour specimens obtained before chemotherapy and at surgery. Tumour shrinkage 450% occurred in 72.1% of patients. Responding patients had higher baseline Hb levels and red blood cell counts than nonresponders (Po0.01 and o0.003, respectively). The distribution of disease response according to increasing cutoffs of baseline Hb status showed that from 12.5 mg l À1 onwards, patients with Hb levels above the cutoff obtained a greater response rate than those with lower Hb values. The difference attained the statistical significance at 12.5 (76.1 vs 59.5%, Po0.05) and 13.0 g/dl À1 (81.0 vs 57.6%, Po0.002) cutoffs, respectively. The predictive role of Hb levels was maintained in multivariate analysis after adjustment for clinical and biological characteristics and treatment regimen. Patients with baseline Hb levels p13 g dl À1 showed a lower treatmentinduced reduction in Ki67 expression (Po0.04) and a higher Ki67 expression at postoperative evaluation (Po0.02) than their counterparts. In conclusion, low Hb levels may negatively influence the response rate of chemotherapy in breast cancer patients. Inhibition of antiproliferative activity could be a possible mechanism.

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Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative chemoradiation therapy for squamous cell carcinoma of the oral cavity and oropharynx

Cited by 243 publications

References 48 publications

Effect of treatment with epoetin beta on short-term tumour progression and survival in anaemic patients with cancer: a meta-analysis

Effect of treatment with epoetin beta on short-term tumour progression and survival in anaemic patients with cancer: a meta-analysis

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

Pretreatment haemoglobin levels significantly predict the tumour response to primary chemotherapy in human breast cancer

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