Erythropoietin (Epo) or darbepoetin (Darbepo) reduce transfusions in anaemic cancer patients but increase the risk for thrombotic complications. Whether Epo/Darbepo effects survival is uncertain.

Bohlius J, Wilson J, Seidenfeld J, Piper M, Schwarzer G, Sandercock J, Trelle S, Weingart O, Bayliss S, Brunskill S, Djulbegovic B, Bennett C, Langensiepen S, Hyde C, Engert A

Published Online:

January 21, 2009

Blood transfusions are one choice of treatment for severe cancer-related anaemia, i.e. haemoglobin level below 8 g/dl. Human erythropoietin is a glycoprotein hormone produced in the kidney. Recombinant human erythropoietin is used to prevent and treat anaemia in cancer patients. This review showed consistent evidence that Epo/Darbepo reduces the risk for blood transfusions and the number of units transfused in anaemic cancer patients. Quality of life might be improved following Epo/Darbepo treatment. However, the risk for thrombotic complications is increased and it remains uncertain whether and how Epo/Darbepo effects tumour control and survival.

Abstract (click to read)

Background:

Anaemia associated with cancer and cancer therapy is an important clinical factor in the treatment of malignant diseases. Therapeutic alternatives are recombinant human erythropoietin (Epo), darbepoetin (Darbepo) and red blood cell transfusions.

Objectives:

The aim of this systematic review was to assess the effects of Epo or Darbepo to either prevent or treat anaemia in cancer patients.

Search strategy:

We searched the Central Register of Controlled Trials, MEDLINE and EMBASE and other data bases. Searches were done for the periods 01/1985 to 12/2001 for the first review and 1/2002 to 04/2005 for the update. We also contacted experts in the field and pharmaceutical companies.

Selection criteria:

Randomised controlled trials on managing anaemia in cancer patients that compared the use of Epo/Darbepo (plus transfusion if needed) with observation until red blood cell transfusion was required.

Data collection and analysis:

Several review authors independently assessed trial quality and extracted data.

Main results:

This update of the systematic review included a total of 57 trials with 9,353 patients. Of these, 27 trials with 3,287 adults were also included in the first Cochrane Review. Thirty trials with 6,066 patients were added during the update process. Use of Epo/Darbepo significantly reduced the relative risk of red blood cell transfusions (RR 0.64; 95% CI 0.60 to 0.68, 42 trials, N = 6,510). On average participants in the Epo/Darbepo group received one unit of blood less than the control group (WMD -1.05; 95% CI -1.32 to -0.78, 14 trials, N = 2,353). For participants with baseline haemoglobin below 12 g/dL haematological response was observed more often in participants receiving Epo/Darbepo (RR 3.43; 95% CI 3.07 to 3.84, 22 trials, N = 4,307). There was suggestive evidence that Epo/Darbepo may improve Quality of Life (QoL). The relative risk for thrombo-embolic complications was increased in patients receiving Epo/Darbepo compared to controls (RR 1.67, 95% CI 1.35 to 2.06; 35 trials, N = 6,769). Uncertainties remain whether and how Epo/Darbepo effects tumour response (fixed-effect RR 1.12; 95% CI 1.01 to 1.23, 13 trials, N = 2,833; random-effects: RR 1.09; 95% CI 0.94 to 1.26) or overall survival (unadjusted and adjusted data: HR 1.08; 95% CI 0.99 to 1.18; 42 trials, N = 8,167).

Authors' conclusions:

There is consistent evidence that administration of Epo/Darbepo reduces the relative risk for blood transfusions and the number of units transfused in cancer patients. For patients with baseline haemoglobin below 12 g/dL (mild anaemia) there is strong evidence that Epo/Darbepo improves haematological response. There is suggestive evidence that Epo/Darbepo may improve QoL. However, there is strong evidence that Epo/Darbepo increases the relative risk for thrombo-embolic complications. Whether and how Epo/Darbepo effects tumour response and overall survival remains uncertain.

This record should be cited as:

Bohlius J, Wilson J, Seidenfeld J, Piper M, Schwarzer G, Sandercock J, Trelle S, Weingart O, Bayliss S, Brunskill S, Djulbegovic B, Bennett C, Langensiepen S, Hyde C, Engert A. Erythropoietin or Darbepoetin for patients with cancer. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD003407. DOI: 10.1002/14651858.CD003407.pub4

Assessed as up to date:

May 24, 2006

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Primary Review Group:

Haematological Malignancies Group

Health topics:

Blood disorders > Haematological malignancies > Haematopoetic growth factors

Cancer > Haematological malignancies > Haematopoetic growth factors

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Erythropoietin (Epo) or darbepoetin (Darbepo) reduce transfusions in anaemic cancer patients but increase the risk for thrombotic complications. Whether Epo/Darbepo effects survival is uncertain.

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