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Erythropoietin is a hormone, produced primarily in the kidney, that helps to regulate production of red blood cells. Epoetin (recombinant human erythropoietin) was developed in the 1980s as a treatment for anemia. Anemia is relatively common among cancer patients and may be caused by the effects of treatment, the underlying disease, or both. According to a recent systematic review of the evidence, use of epoetin can reduce anemia and anemia-related transfusions for some cancer patients.
A comprehensive review of controlled clinical trials on the benefits of epoetin for cancer patients with anemia was conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center, which is supported by the Agency for Healthcare Research and Quality (contract 290-97-0015). A team of researchers led by Naomi Aronson, Ph.D., reviewed studies comparing the outcomes of managing anemia with epoetin with transfusion alone in four patient groups: one, anemia due primarily to cancer therapy; two, anemia due primarily to malignancy; three, patients who are anemic as a result of bone marrow ablation prior to autologous stem-cell transplantation (using the patient's own stem cells); and four, patients who are anemic as a result of allogeneic stem-cell transplantation (using donor stem cells).
The most robust evidence showed that epoetin treatment improved transfusion outcomes of cancer patients concurrently undergoing cancer therapy (radiation or chemotherapy). Consistent evidence demonstrated that epoetin reduced transfusion requirements if treatment was begun when declining hemoglobin levels approach 10 g/dL. More limited evidence suggested that epoetin also improved quality of life for mildly anemic patients. However, definitive information on the optimal hemoglobin threshold and dosing for initiating epoetin treatment remains unclear. Finally, evidence showed epoetin modestly decreased time (by 1 to 2 weeks) to red cell engraftment for those undergoing allogeneic (but not autologous) stem cell rescue following bone marrow ablation.
More details are in "Systematic review of controlled trials on erythropoietin to support evidence-based guidelines," by Jerome Seidenfeld, Ph.D., Margaret Piper, Ph.D., and Dr. Aronson, in the September 2002 Oncology 16(9), pp. 171-188.
Editor's Note: Copies of AHRQ Evidence Report/Technology Assessment No. 30, Uses of Epoetin in Oncology (AHRQ Publication No. 01-E009), are available from the AHRQ Publications Clearinghouse.
Copies of the summary of the report (AHRQ Publication No. 01-E008) are available from the AHRQ Publications Clearinghouse.
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