Onkologie. 2010:4(1):32-39

Update on Erythropoiesis-Stimulating Agents and Clinical Trials in Oncology

Matti Aapro¹, Jerry L.Spivak²

¹ Multidisciplinary Oncology Institute, Genolier, Switzerland

² Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA

Anemia commonly occurs among cancer patients receiving chemotherapy. In these patients, erythropoiesisstimulating agents (ESAs) are

effective in managing anemia but there is an increased risk for thrombovascular events. In more recent randomized clinical trials, there

have been differing results regarding the impact of ESAs on overall survival and mortality. The balance between studies that show higher

ESA-associated mortality and those that don’t show ESA-associated mortality is examined in this review. This review discusses where

we stand today on anemia management in cancer patients. Preliminary results from a recent independent patient data meta-analysis

for on-study deaths and overall survival in patients receiving chemotherapy (the only oncology population for which ESA treatment

is currently indicated) showed no statistically significant difference between the ESA and control groups (onstudy deaths hazard ratio

[HR], 1.10; 95% confidence interval [CI], 0.98 –1.24; overall survival HR, 1.04; 95% CI, 0.97–1.11, compared with controls). Possible factors

that could influence study results are discussed in this review. There are no convincing data to support ESAinduced tumor stimulation

in patients. ESAs decrease RBC transfusion needs and sustain targeted hemoglobin levels, and this ESA response does not significantly

impact overall survival or mortality when ESAs are used within guidelines and labeling. However, based on the currently available data

and meta-analysis, the use of ESAs has to be carefully balanced against any possible risk for higher mortality.

Keywords: anemia, erythropoiesis-stimulating agents, guidelines

Published: March 1, 2010  Show citation