Erythropoietin and cancer death rates
Erythropoiesis-stimulating agents (ESAs) may increase the risk of death in cancer patients according to a new meta-analysis, which also suggests that the drugs are associated with a significant risk of venous thromboembolism (VTE).1
Researchers evaluated Phase 3 trials comparing ESAs (erythropoietin and darbepoetin) with placebo or standard care in the treatment of anemia among patients with cancer. The study included 51 trials with 13,611 patients that included survival information, and 38 clinical trials with 8,172 patients that included information on VTE.
Cancer patients who received ESAs had a higher rate of VTE (7.5% vs 4.9%, RR 1.57 7:95% CI, 1.31-1.87) and increased mortality risks (hazard ratio 1.10: 95% CI, 1.01-1.20). The risk of VTE has been previously reported, but this is the first report that raises the issue of increased mortality associated with use of the drugs. The authors cite eight recent studies that have shown increased rates of tumor progression or mortality with ESA use. These trials raise the concern that the ESAs directly affect tumors, a plausible theory since expression of erythropoietin and erythropoietin receptors has been demonstrated in a variety of human cancers and stimulation of these receptors has been shown to cause tumor effects including proliferation, antiapoptosis, and invasion.
The authors conclude that the ESA administration to patients with cancer is associated with increased VTE and mortality risks, and they raise concerns about the safety of ESA administration to patients with cancer.
Reference
1. Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and Darbepoetin administration for the treatment of cancer-associated anemia. JAMA 2008; 299:914-924.
Erythropoiesis-stimulating agents (ESAs) may increase the risk of death in cancer patients according to a new meta-analysis, which also suggests that the drugs are associated with a significant risk of venous thromboembolism (VTE).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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