Erythropoietic agents in the management of cancer patients. Part 1: Anemia, quality of life, and possible effects on survival.
Erythropoietic agents have been shown to be well tolerated and highly effective in correcting the anemia associated with cancer. Studies aimed at optimizing their use in this regard are ongoing and are evaluating the potential value of early dose intensification through "front-loading" schedules, the feasibility of reducing the frequency of dosing, and the value of early initiation of erythropoietic agents to prevent anemia. The potential for erythropoietic therapy to contribute to survival in cancer patients also is being investigated. Anemia is an independent poor prognostic factor in several cancer settings, such as head-and-neck, lung, and cervical cancer. In patients with B-cell chronic lymphocytic leukemia, it is possible that the period of stable disease--that is, postponement of the need for cytotoxic chemotherapy--may be prolonged when patients are "downstaged" through correction of their anemia. In addition, anemia may affect the patient's quality of life in ways that impact compliance and/or the ability to tolerate therapy. Retrospective analysis of large phase III trials designed to evaluate the effect of erythropoietic agents on anemia in cancer patients has reported a trend toward improved survival among patients who received erythropoietic therapy. Trials to evaluate how correction of anemia in cancer patients might impact survival are ongoing. In this first installment of a two-part article, the author reviews the clinical data supporting the use of erythropoietic agents for the management of the fatigue due to anemia, the effect of anemia control on quality of life, and the evidence available so far that control of such anemia may actually lengthen survival. In the next issue, Dr. Smith will discuss the possible role of erythropoietic agents in neuroprotection and neurotherapy, including cognitive dysfunction in cancer patients.
Smith
Robert E
RE
South Carolina Cancer Center, and South Carolina Oncology Associates, Columbia, South Carolina 29201, USA. rsmith@sconcology.net
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D011788:Quality of Life; D016019:Survival Analysis
D004921:Erythropoietin