Anemia in the News

A recent article published in The Lancet concluded that the use of erythropoiesis-stimulating agents (ESAs) increased mortality and worsened overall survival for treatment of cancer patients with anemia.

Data from nearly 14,000 patients from 53 separate clinical trials was analyzed to compare the safety of ESA plus transfusion treatment against transfusion-only treatment. The results showed that patients who received ESAs in addition to transfusions experienced a 17% higher mortality rate during the active study period and a 6% lower overall survival rate than patients only receiving transfusions. For the subset of patients in this study undergoing chemotherapy (10,441 patients in 38 trials) mortality was 10% higher and overall survival was lower by 4%, although not reaching statistical significance.

“Considering the benefits and risks known at present, the use of ESAs according to the FDA recommendations remains advisable,” said Dr. Lodovico Balducci, chief of the division of Geriatric Oncology at H. Lee Moffitt Cancer Center. Dr. Balducci further explained that data from this meta-analysis suggest that ESAs should be administered thoughtfully to cancer patients as should be the case with all forms of treatment.

Transfusions are also used to treat chemotherapy-induced anemia to raise a cancer patient’s hemoglobin level when there is little or no response to ESA therapy, explained Dr. David Henry, a member of the Society for Advancement of Blood Management (SABM) and a clinical professor of medicine specializing in hematology/oncology at the University of Pennsylvania. Recent information suggests that patients who continue ESA therapy after minimal response to the drug, often experience worse tumor outcomes, especially when they go on to need transfusions. In our practice, “we always discontinue the ESAs if they are not working after a 4-8 week trial,” affirmed Dr. Henry.

Some clinical trials have associated ESA treatment for cancer patients with serious adverse effects like heart attacks, tumor progression and increased mortality. These results prompted the FDA, in July of 2008, to restrict ESA use only to patients actively receiving chemotherapy.

Last Updated: October 19, 2009

NAAC experts have further commented on this published article in a Research Review published June 2009.