HEMONC: The impact of recently published negative erythropoiesis-stimulating agent studies on the clinical management of cancer-related anemia at a single center The impact of recently published negative erythropoiesis-stimulating agent studies on the clinical management of cancer-related anemia at a single center ================================================================================

Hikmat Abdel-Razeq, Shadi Hijjawi, Hazem Abdulelah, Rula Amarin, Majid Asawaeer, Haitham Shaheen

on 14/06/2010 08:34:00 Anemia is the most common hematological abnormality in cancer patients. Unfortunately, it is often under-recognized and under-treated. The pathogenesis of cancer-related anemia is complex and often multifactorial. While both radiotherapy and chemotherapy can be immunosuppressive and inhibit erythropoiesis, some treatments cause a greater degree of anemia than others.1 A significant portion of cancer patients with anemia have no identifiable causes; the anemia in this situation is classified as anemia of chronic disease. The underlying mechanisms responsible for this type of anemia are unclear, but are thought to involve the activation of cytokines such as interleukin-1 and tissue necrosis factor (TNF). These cytokines may suppress endogenous erythropoietin (EPO) production, impair iron utilization and reduce erythroid precursor proliferation.2 Anemia can cause a wide range of symptoms involving almost every organ. The severity of these symptoms depends on several factors such as the degree of anemia, rapidity of onset and co-morbidities. These symptoms range from dizziness and palpitation to pulmonary edema, heart failure, depression and even cognitive impairment.3 Fatigue, a common symptom in cancer patients, is considered an important factor that adversely affects the quality of life (QOL) in such patients.4,5 While cancer fatigue has different pathogenetic mechanisms, anemia is believed to be a significant contributing factor.6 Additionally, there is increasing evidence to suggest that anemia is an independent factor that can adversely affect survival in cancer patients.7,8 Recombinant human erythropoiesis stimulating agents (ESAs) have been in use for many years to treat anemia associated with cancer and chemotherapy. Several studies have demonstrated that ESAs were effective in increasing hemoglobin levels as compared to placebo.9-11 However, many recent studies involving patients with different kind of cancers at different stages of their disease suggest a negative impact on disease progression and survival when ESAs were used to keep hemoglobin at a higher level.12-18 This report describes the prevalence of anemia in cancer patients and recent trends in its management at our institution following the recent confusion and uncertainties about the safety of ESAs in the treatment of anemia in cancer patients.