Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Italy.
Oncologist. 2012;17(5):715-24. doi: 10.1634/theoncologist.2012-0024. Epub 2012 Apr 24.
Anemia is a common manifestation in patients with cancer. Little is known about the frequency of and risk for anemia with targeted therapies used to treat solid tumors.
We performed a meta-analysis of randomized controlled trials of solid tumors by comparing targeted therapy (alone or in combination) with standard therapy alone to calculate the incidence and relative risk (RR) for anemia events associated with these agents. Overall, 24,310 patients were included in the analysis.
The addition of targeted therapies to standard treatment (chemotherapy or placebo/best supportive care) increased the risk for all grades of anemia by 7%. The RR for all grades (incidence, 44%) and grades 1-2 (incidence, 38.9%) of anemia was higher with biological therapies alone but not when combined with chemotherapy. The risk was significant for erlotinib, trastuzumab, and sunitinib. Bevacizumab was associated with a lower risk for anemia. Anti-epidermal growth factor receptor, anti-human epidermal growth factor receptor 2, anti-vascular endothelial growth factor receptors, and tyrosine kinase inhibitors predicted RRs of 1.24, 1.20, 0.82, and 1.33, respectively, and all of these values were significant.
Grade 1-2 anemia is frequently associated with biological agents. The risk is particularly associated with small-molecule tyrosine kinase inhibitors (gefitinib and erlotinib), breast cancer, and lung cancer. Erythropoiesis-stimulating agents are not labeled for use with targeted therapies (without chemotherapy) and the treatment is supportive only.
贫血是癌症患者的常见表现。对于用于治疗实体瘤的靶向治疗药物引起贫血的频率和风险，知之甚少。
我们通过比较靶向治疗（单独或联合）与标准治疗（单独化疗或安慰剂/最佳支持治疗）对实体瘤的随机对照试验进行荟萃分析，以计算与这些药物相关的贫血事件的发生率和相对风险（RR）。共有 24310 名患者纳入分析。
与标准治疗（化疗或安慰剂/最佳支持治疗）相比，添加靶向治疗会增加所有级别贫血的风险 7%。生物治疗单独应用时，所有级别（发生率为 44%）和 1-2 级（发生率为 38.9%）贫血的 RR 更高，但与化疗联合应用时则不然。厄洛替尼、曲妥珠单抗和舒尼替尼的风险显著增加。贝伐单抗与贫血风险降低相关。抗表皮生长因子受体、抗人表皮生长因子受体 2、抗血管内皮生长因子受体和酪氨酸激酶抑制剂的 RR 分别为 1.24、1.20、0.82 和 1.33，所有这些值均有统计学意义。
1-2 级贫血常与生物制剂相关。风险尤其与小分子酪氨酸激酶抑制剂（吉非替尼和厄洛替尼）、乳腺癌和肺癌相关。促红细胞生成素刺激剂未被批准与靶向治疗（无化疗）联合使用，治疗仅为支持性治疗。
