Engert A
Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Germany.
Ann Oncol. 2005 Oct;16(10):1584-95. doi: 10.1093/annonc/mdi307. Epub 2005 Jun 15.
Anaemia effects up to 90% of cancer patients, with more than 60% requiring blood transfusion during or after treatment. With the advent of recombinant human erythropoietins (rHuEPO), an alternative to red blood cell transfusion has become available. So far, three drugs have been approved for the treatment of anaemia in patients with malignancies (epoetin alfa, epoetin beta and darbepoetin alfa). New concepts for the use of erythropoietin in cancer patients include 3- and 4-weekly dosing, as well as loading-dose concepts. Important factors helping to judge the impact of erythropoietin in cancer treatment include pharmacoeconomics and better predictive factors. Lately, the influence of erythropoietin therapy on survival in cancer patients has been discussed very intensively, because conflicting data have emerged. Studies aimed at correcting anaemia in cancer patients had indicated a possible survival advantage of those patients receiving erythropoietin. In contrast, two recent trials aimed at correction of haemoglobin levels beyond anaemia reported a poorer survival of patients receiving erythropoietin. This might grossly be attributed to a higher risk of thrombosis in these patients. The largest systematic review on the use of erythropoietin in cancer patients undergoing treatment indicates a suggestive but not significant survival advantage of erythropoietin-treated patients. In addition, very recent results of a Food and Drug Administration meeting on safety and survival of patients treated with erythropoietin are presented.
贫血影响高达90%的癌症患者，超过60%的患者在治疗期间或治疗后需要输血。随着重组人促红细胞生成素（rHuEPO）的出现，红细胞输血的替代方法已可供使用。到目前为止，已有三种药物被批准用于治疗恶性肿瘤患者的贫血（阿法依泊汀、贝他依泊汀和达贝泊汀α）。促红细胞生成素在癌症患者中的新应用概念包括每3周和4周给药一次，以及负荷剂量概念。有助于判断促红细胞生成素在癌症治疗中影响的重要因素包括药物经济学和更好的预测因素。最近，促红细胞生成素治疗对癌症患者生存的影响已得到深入讨论，因为出现了相互矛盾的数据。旨在纠正癌症患者贫血的研究表明，接受促红细胞生成素治疗的患者可能具有生存优势。相比之下，最近两项旨在将血红蛋白水平纠正至贫血水平以上的试验报告称，接受促红细胞生成素治疗的患者生存率较低。这可能主要归因于这些患者发生血栓形成的风险较高。关于促红细胞生成素在接受治疗的癌症患者中的应用的最大规模系统评价表明，接受促红细胞生成素治疗的患者有提示性但不显著的生存优势。此外，还介绍了食品药品监督管理局关于促红细胞生成素治疗患者安全性和生存情况会议的最新结果。
