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Cancer-related anemia and recombinant human erythropoietin—an updated overview

Nature Clinical Practice Oncology volume 3, pages 152–164 (2006)Cite this article

Abstract

For cancer patients, anemia can be a debilitating problem that negatively influences their overall quality of life and worsens their prognosis. The condition is caused either by the cancer itself or by cytotoxic treatment. Anemia is the primary indication for transfusion of red blood cells, but the development of recombinant human erythropoietins (epoetins) provides an alternative to red blood cell transfusions. Treatment with epoetins has been shown to reduce transfusion rates and increase hemoglobin response. There is some evidence that epoetins improve quality of life. It remains unclear, however, whether erythropoietin affects tumor growth and survival, and this area requires further investigation. Data from clinical trials suggest that erythropoietin increases the risk of thromboembolic complications. In the management of anemic patients, physicians should follow closely the dosing recommendations in products' package inserts or the ASCO/American Society of Hematology guidelines. Treatment of patients beyond the correction of anemia, however, has to be regarded as experimental and is potentially harmful, so should only be conducted in clinical trials.

Key Points

  • The pathophysiology of tumor anemia is multifactorial, and treatment with recombinant human erythropoietins has been shown to reduce transfusion rates and increase hemoglobin (Hb) response

  • For many cancers anemia is known to be a factor associated with a worse prognosis

  • In cancer patients, cytostatic therapy and radiation can aggravate anemia, and platinum-based chemotherapy regimens might diminish endogenous erythropoietin

  • Dose-intensified treatment regimens or shortened treatment intervals are associated with a higher degree of anemia

  • Systematic review analysis showed that patients receiving erythropoietin are three to four times more likely to achieve Hb response (Hb increase of 2 g/dl) than those not treated with this agent

  • Thromboembolic complications can be increased in patients receiving erythropoietin, and is not recommended in patients with Hb levels >12 g/dl

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Figure 1: Pathophysiology of anemia.
Figure 2: Meta-analysis of the relative risk to receive red blood cell transfusions for cancer patients receiving erythropoietin or standard care.

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Authors and Affiliations

  1. Cochrane Haematological Malignancies Group,

    Julia Bohlius, Olaf Weingart & Andreas Engert

  2. Department I of Internal Medicine, at the University of Cologne, Cologne, Germany

    Julia Bohlius, Olaf Weingart & Andreas Engert

  3. research fellow at the Division of Epidemiology and Biostatistics, University of Berne, Berne, Switzerland

    Sven Trelle

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Correspondence to Andreas Engert.

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Bohlius, J., Weingart, O., Trelle, S. et al. Cancer-related anemia and recombinant human erythropoietin—an updated overview. Nat Rev Clin Oncol 3, 152–164 (2006). https://doi.org/10.1038/ncponc0451

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