Xiaomei Li1, Zhi Yan1, Dexiao Kong1, Wen Zou1, Jihua Wang1, Dianshui Sun1, Yuhua Jiang1, Chengyun Zheng1. 1. 1 Cancer Center of the Second Hospital, 2 Institute of Biotherapy for Hematological Malignancies, 3 Cardiovascular Department of the Second Hospital, 4 Hematology Department of the Second Hospital, 5 Pharmacology Department of the Second Hospital, Shandong University, Jinan 250100, China.
Abstract
BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are widely used in the management of anemia in cancer patients. Despite their apparent effectiveness, recent studies have suggested that ESAs could result in serious adverse events and even higher mortality. The aim of the current study was to evaluate the benefits and risks of ESAs in the management of cancer patients with anemia using a meta-analysis. METHODS: The initial literature search covered Medline, PubMed, Embase, and the Cochrane Center Register of Controlled Trials, and identified 1,569 articles. The final meta-analysis included eight randomized controlled trials (n=2,387) in cancer patients with <11 g/dL hemoglobin (Hb) at the baseline and target Hb (for stopping ESA treatment) at no more than 13 g/dL. The assessment measures included Hb response, blood transfusion rate and adverse events that included venous thromboemblism (VTE), hypertension, and on-study mortality. The results are expressed as pooled odds ratio (OR). Publication bias was assessed using funnel plot analysis. RESULTS: ESAs significantly increased the Hb concentration [OR 7.85, 95% confidence interval (CI): 5.85 to 10.53, P<0.001] and reduced the red blood cell (RBC) transfusion rate (OR 0.52, 95% CI: 0.42 to 0.65, P<0.001). ESAs did not increase the accumulated adverse events (OR 0.95, P=0.82), or the on-study mortality (OR 1.09, P=0.47). CONCLUSIONS: ESAs are not associated with increased frequency of severe adverse events in anemic cancer patients when the target Hb value is no more than 13 g/dL.
BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are widely used in the management of anemia in cancerpatients. Despite their apparent effectiveness, recent studies have suggested that ESAs could result in serious adverse events and even higher mortality. The aim of the current study was to evaluate the benefits and risks of ESAs in the management of cancerpatients with anemia using a meta-analysis. METHODS: The initial literature search covered Medline, PubMed, Embase, and the Cochrane Center Register of Controlled Trials, and identified 1,569 articles. The final meta-analysis included eight randomized controlled trials (n=2,387) in cancerpatients with <11 g/dL hemoglobin (Hb) at the baseline and target Hb (for stopping ESA treatment) at no more than 13 g/dL. The assessment measures included Hb response, blood transfusion rate and adverse events that included venous thromboemblism (VTE), hypertension, and on-study mortality. The results are expressed as pooled odds ratio (OR). Publication bias was assessed using funnel plot analysis. RESULTS: ESAs significantly increased the Hb concentration [OR 7.85, 95% confidence interval (CI): 5.85 to 10.53, P<0.001] and reduced the red blood cell (RBC) transfusion rate (OR 0.52, 95% CI: 0.42 to 0.65, P<0.001). ESAs did not increase the accumulated adverse events (OR 0.95, P=0.82), or the on-study mortality (OR 1.09, P=0.47). CONCLUSIONS: ESAs are not associated with increased frequency of severe adverse events in anemic cancerpatients when the target Hb value is no more than 13 g/dL.
Authors: Brian Leyland-Jones; Vladimir Semiglazov; Marek Pawlicki; Tadeusz Pienkowski; Sergei Tjulandin; George Manikhas; Antoly Makhson; Anton Roth; David Dodwell; Jose Baselga; Mikhail Biakhov; Konstantinas Valuckas; Edouard Voznyi; Xiangyang Liu; Els Vercammen Journal: J Clin Oncol Date: 2005-08-08 Impact factor: 44.544
Authors: Anders Osterborg; Matti Aapro; Paul Cornes; Anton Haselbeck; Colin R W Hayward; Wolfgang Jelkmann Journal: Eur J Cancer Date: 2006-12-05 Impact factor: 9.162
Authors: Enrique Hernandez; Peter Ganly; Veena Charu; Joseph Dibenedetto; Dianne Tomita; Tom Lillie; Kerry Taylor Journal: Curr Med Res Opin Date: 2009-09 Impact factor: 2.580
Authors: C E Halstenson; M Macres; S A Katz; J R Schnieders; M Watanabe; J T Sobota; P A Abraham Journal: Clin Pharmacol Ther Date: 1991-12 Impact factor: 6.875
Authors: Johan Vansteenkiste; Robert Pirker; Bartomeu Massuti; Fernando Barata; Albert Font; Michael Fiegl; Salvatore Siena; Jenni Gateley; Dianne Tomita; Alan B Colowick; Jaromir Musil Journal: J Natl Cancer Inst Date: 2002-08-21 Impact factor: 13.506
Authors: A M Sinclair; N Rogers; L Busse; I Archibeque; W Brown; P D Kassner; J E V Watson; G E Arnold; K C Q Nguyen; S Powers; S Elliott Journal: Br J Cancer Date: 2008-03-18 Impact factor: 7.640