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Evidence summaries

Erythropoietin or Darbepoetin for Patients with Malignant Disease

Administration of erythropoietin or darbepoetin reduces the need for red blood cell transfusions in anaemic cancer patients but increases on-study mortality and thromboembolic complications and appears to decrease overall survival. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 91 studies with a total of 20 101 subjects to assess the effects of recombinant human erythropoiesis-stimulating agents (ESAs) to either prevent or treat anaemia in cancer patients. Studies evaluating the use of ESAs to prevent or reduce anaemia in cancer patients, given singly or concomitantly with chemotherapy, radiotherapy or combination therapy were included.

Hematologic response, need for red blood cell (RBC) transfusions, overall survival and on-study mortality were primary endpoints. The main findings are given in Table 1.

Table 1

OutcomeNumber of participants (studies)Assumed risk (control)Corresponding risk (erythropoietin or darpoietin)Relative effect(95% CI)
Patients receiving RBC transfusions15 877 (70)389 per 1000195 per 1000(186 to 204 per 1000)RR 0.65 (0.62 to 0.68)
Overall survival19 003 (78)142 per 1000149 per 1000(142 to 156 per 1000)HR 1.05 (1 to 1.11)
On-study mortality15 935 (70)59 per 100069 per 1000(62 to 75 per 1000)HR 1.17 (1.06 to 1.29)
Thrombotic events15278 (57)46 per 100070 per 1000(61 to 80 per 1000)RR 1.52 (1.33 to 1.73)

Another Cochrane review [Abstract] 2 included 53 studies with a total of 13 933 cancer patients. The trials compared epoetin or darbepoetin plus red blood cell transfusions (as necessary) versus red blood cell transfusions (as necessary) alone to prevent or treat anemia in adult or pediatric cancer patients with or without concurrent antineoplastic therapy. A total of 1530 patients died on-study and 4993 overall. Erythropoietin stimulating agents increased on-study mortality (combined hazard ratio [cHR] 1.17; 95% CI 1.06-1.30) and worsened overall survival (cHR 1.06; 95% CI 1.00-1.12). Thirty-eight trials enrolled 10441 patients receiving chemotherapy. The cHR for on study mortality was 1.10 (95% CI 0.98-1.24) and 1.04 (95% CI 0.97-1.11) for overall survival. There was little evidence for a difference between trials of patients receiving different cancer treatments (P for interaction=0.42).

    References

    • Tonia T, Mettler A, Robert N et al. Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev 2012;(12):CD003407. [PubMed]
    • Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J, Zwahlen M, Clarke MJ, Weingart O, Kluge S, Piper M, Napoli M, Rades D, Steensma D, Djulbegovic B, Fey MF, Ray-Coquard I, Moebus V, Thomas G, Untch M, Schumacher M, Egger M, Engert A. Erythropoietin or Darbepoetin for patients with cancer--meta-analysis based on individual patient data. Cochrane Database Syst Rev 2009 Jul 8;(3):CD007303. [PubMed]

Primary/Secondary Keywords