NEW YORK (Reuters Health) Feb 29 - Lung cancer patients can safely receive erythropoiesis-stimulating agents (ESAs) during chemotherapy, according to findings from a new meta-analysis.
"The consequence of chemotherapy-induced anemia is particularly important for lung cancer patients as the symptoms of anemia (fatigue, dyspnea, lack of energy) are often superimposed on similar symptoms related to the lung cancer itself or the smoking related comorbidity (COPD in particular)," said lead author Dr. Johan Vansteenkiste from University Hospital Gasthuisberg, Leuven, Belgium in email to Reuters Health.
"ESAs are of particular interest for lung cancer patients who go below a hemoglobin of 10 g/dL during their chemotherapy," he said.
Dr. Vansteenkiste and colleagues assessed the efficacy and safety of ESAs in lung cancer by conducting meta-analyses of 10 controlled studies of ESA in lung cancer that reported mortality. Altogether the studies evaluated 2,412 lung cancer patients (1,227 treated with ESA and 1,185 controls).
In the nine trials in which patients received chemotherapy, there was no difference in the risk of death between ESA-treated patients and controls, regardless of whether they had small-cell lung cancer (SCLC) or non-small-cell lung cancer (NSCLC), according to a report online January 24 in Lung Cancer.
In the sole study conducted in patients not receiving chemotherapy or radiation, mortality did not differ significantly between patients who did and didn't receive ESAs.
In eight studies that reported on transfusions during chemotherapy, the need for transfusion was 66% lower among ESA-treated patients than among controls.
Patient-level data from four trials of darbepoetin alfa showed median survival of 41 weeks in darbepoetin patients, compared with 38 weeks in controls (a non-significant difference), and transfusions were about half as frequent in the darbepoetin group.
Patients treated with darbepoetin were more likely to report an adverse event of interest than were patients treated with placebo (27.0% vs 22.9%, respectively), with the difference primarily due to higher rates of thrombotic and embolic events in the darbepoetin patients than in the placebo group (10.5% vs 7.2%).
"Results of these analyses are consistent with findings reported for patients with various tumor types," the researchers note.
"ESA is a rewarding and safe treatment" for lung cancer patients with chemotherapy-induced anemia, Dr. Vansteenkiste said.
But, he cautioned, "because of concerns about possible negative effects of ESAs on survival, it is advised to assess the benefit versus risk ratio very carefully in patients who have chemotherapy for curative intent (adjuvant, neo-adjuvant)."
"Nonetheless, there have been no signals of worse outcome when ESAs were used for chemotherapy-induced anemia in studies with lung cancer patients," he added.
The study was funded by Amgen Inc., which markets darbepoetin as Aranesp. The company also markets epoetin alfa as Epogen. Four of the paper's eight authors reported financial relationships with Amgen, and two authors are employees and shareholders. Amgen employees or contractors performed the literature search and statistical analyses, compiled authors' contributions, and coordinated draft reviews.
SOURCE: http://bit.ly/wupiAL
Lung Cancer 2012.
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