title: Erythropoiesis-stimulating agents in oncology: a study-level meta-analysis of survival and other safety outcomes.
abstract: BACKGROUND
  Cancer patients often develop the potentially debilitating condition of anaemia. Numerous controlled studies indicate that erythropoiesis-stimulating agents (ESAs) can raise haemoglobin levels and reduce transfusion requirements in anaemic cancer patients receiving chemotherapy. To evaluate recent safety concerns regarding ESAs, we carried out a meta-analysis of controlled ESA oncology trials to examine whether ESA use affects survival, disease progression and risk of venous-thromboembolic events.
  
  
  METHODS
  This meta-analysis included studies from the 2006 Cochrane meta-analysis, studies published/updated since the 2006 Cochrane report, and unpublished trial data from Amgen and Centocor Ortho Biotech. The 60 studies analysed (15 323 patients) were conducted in the settings of chemotherapy/radiochemotherapy, radiotherapy only treatment or anaemia of cancer. Data were summarised using odds ratios (ORs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Results indicated that ESA use did not significantly affect mortality (60 studies: OR=1.06; 95% CI: 0.97-1.15) or disease progression (26 studies: OR=1.01; 95% CI: 0.90-1.14), but increased the risk for venous-thromoboembolic events (44 studies: OR=1.48; 95% CI: 1.28-1.72).
  
  
  CONCLUSIONS
  Though this meta-analysis showed no significant effect of ESAs on survival or disease progression, prospectively designed, future randomised clinical trials will further examine the safety and efficacy of ESAs when used according to the revised labelling information.
authors.affiliation: Department of Medicine-Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, 100 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095-6996 USA. jglaspy@mednet.ucla.edu
authors.forename: J
authors.initials: J
authors.lastname: Glaspy
authors.forename: J
authors.initials: J
authors.lastname: Crawford
authors.forename: J
authors.initials: J
authors.lastname: Vansteenkiste
authors.forename: D
authors.initials: D
authors.lastname: Henry
authors.forename: S
authors.initials: S
authors.lastname: Rao
authors.forename: P
authors.initials: P
authors.lastname: Bowers
authors.forename: J A
authors.initials: JA
authors.lastname: Berlin
authors.forename: D
authors.initials: D
authors.lastname: Tomita
authors.forename: K
authors.initials: K
authors.lastname: Bridges
authors.forename: H
authors.initials: H
authors.lastname: Ludwig
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D006397:Hematinics