title: Survival and erythropoietin receptor protein in tumours from patients randomly treated with rhEPO for palliative care.
abstract: BACKGROUND
  Recombinant erythropoietin (rhEPOalpha) corrects anaemia, improves physical functioning and quality of life in cancer patients. However, published reports have suggested risks for tumour stimulation by provision EPO to patients with remaining tumour cells perhaps related to the presence of EPO receptor protein in tumour tissue. Therefore, the aim of the present study was to exclude a possibility that cancer patients who respond favourably to EPO treatment have mainly tumours with low EPO receptor protein expression.
  
  
  METHODS
  Tumour tissue was evaluated in 87 patients out of 108 randomly allocated for treatment with rhEPOalpha (n = 50) versus controls (n = 58). Tumour cell proliferation (Ki-67 index) and EPO receptor protein expression were evaluated by immunohistochemistry.
  
  
  RESULTS
  EPO treatment varied between 2 and 35 months, in doses between 10,000 and 40,000 Units/week. Ki-67 index did not differ between study and control patients before EPO treatment. Tumour tissue erythropoietin receptor protein was also similar between treated and untreated patients. Around 40% of tumour cells contained EPO receptors. Survival did not differ among EPO treated and control patients analysed as intention to treat, while survival was significantly improved in EPO treated patients per protocol treatment (P < 0.05). Ki-67 index and tumour tissue erythropoietin receptor protein did not predict survival, which systemic inflammation (ESR) did (P < 0.02).
  
  
  CONCLUSIONS
  Our results support that reported risk to accelerate disease progression by EPO treatment in palliative care is not justified in patients with solid, gastrointestinal cancer despite tumour presence of EPO receptor protein.
authors.affiliation: Department of Surgery, Surgical Metabolic Research Laboratory at Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, Göteborg University, 413 45, Göteborg, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Lönnroth
authors.forename: Marie
authors.initials: M
authors.lastname: Svensson
authors.forename: Wenhua
authors.initials: W
authors.lastname: Wang
authors.forename: Ulla
authors.initials: U
authors.lastname: Körner
authors.forename: Peter
authors.initials: P
authors.lastname: Daneryd
authors.forename: Ola
authors.initials: O
authors.lastname: Nilsson
authors.forename: Kent
authors.initials: K
authors.lastname: Lundholm
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D009369:Neoplasms / Q000737:chemistry / Q000150:complications* / Q000401:mortality / Q000473:pathology; D010166:Palliative Care; D017467:Receptors, Erythropoietin / Q000032:analysis*; D011994:Recombinant Proteins
chemical_list: D019394:Ki-67 Antigen; D017467:Receptors, Erythropoietin; D011994:Recombinant Proteins; D004921:Erythropoietin