Preclinical and clinical effects of erythropoietin in the management of anaemia in patients with non-small cell lung cancer.

The myelosuppressive toxicities of chemotherapy are one of the principle reasons for the overall failure of some agents to have a meaningful impact on responses and survival in cancer, and anaemia is a common side-effect of almost all cytostatic drugs used clinically. As regulators of haematopoietic homeostasis, cytokines mediate cellular proliferation, differentiation and survival. Among the various growth factors currently available, erythropoietin (EPO) is the principle factor responsible for the regulation of red blood cell production during steady-state conditions and for accelerating recovery following cytostatic bone marrow depletion. Many studies have provided evidence that EPO is able to correct and to prevent anaemia in approximately 64% of cancer patients with subsequent reduction of blood transfusion requirement. Among the prognostic factors for survival in patients with advanced non-small cell lung cancers (NSCLC), anaemia is associated with reduced response rates and quality of life, and a poorer prognosis. Recently, some studies suggest a possible relationship between increased haemoglobin levels and survival in NSCLC patients. Furthermore, there is evidence that NSCLC patients with high haemoglobin levels have a better outcome after radio- or chemotherapy. Although the highest rate of transfusion-dependent patients (34%) has been observed in patients suffering from NSCLC, there are no universally accepted guidelines addressing the most effective methods of monitoring NSCLC patients for anaemia. Thus, further randomized, controlled trials are needed to evaluate the effect of any therapeutic intervention against anaemia on survival and disease control in patients with NSCLC.