Department of Medical Oncology, IMO Clinique de Genolier, 3 route du Muids, 1272 Genolier, Switzerland.
Ann Oncol. 2012 Sep;23 Suppl 10:x289-93. doi: 10.1093/annonc/mds345.
Erythropoiesis-stimulating agents (ESAs) increase red blood cell (RBC) production by activating the erythropoietin receptor on erythrocytic progenitor cells. ESAs are approved in the United States and Europe for treating anaemia in cancer patients receiving chemotherapy. ESA safety issues include thromboembolic events and there have been concerns about disease progression and/or mortality in cancer patients. This educational supplement paper is based on two recently published papers. We review both clinical trial data on ESAs and disease progression and preclinical data on how ESAs could affect tumour growth. We conclude that ESAs may have little effect on disease progression in chemotherapy patients, and preclinical data indicate a direct or indirect effect of ESAs on tumour growth is not strongly supported. We also summarise the mechanisms and clinical consequences of iron deficiency and anaemia in cancer patients. Randomised clinical trials have shown superior efficacy of i.v. iron over oral or no iron in reducing blood transfusions, increasing haemoglobin, and improving quality of life in ESA-treated anaemic advanced cancer patients. Furthermore, i.v. iron without additional ESA should be evaluated as potential treatment in patients with chemotherapy-induced anaemia. at recommended doses, i.v. iron is well tolerated, particularly compared with oral iron, but caution should be used in some specific situations.
促红细胞生成素刺激剂（ESAs）通过激活红细胞祖细胞上的促红细胞生成素受体来增加红细胞（RBC）的产生。ESA 在美国和欧洲被批准用于治疗接受化疗的癌症患者的贫血。ESA 的安全性问题包括血栓栓塞事件，并且人们一直担心癌症患者的疾病进展和/或死亡率。本教育补充文件基于最近发表的两篇论文。我们回顾了 ESA 的临床试验数据以及疾病进展和关于 ESA 如何影响肿瘤生长的临床前数据。我们的结论是，ESA 可能对化疗患者的疾病进展影响不大，并且临床前数据表明 ESA 对肿瘤生长的直接或间接影响并没有得到强有力的支持。我们还总结了癌症患者铁缺乏和贫血的机制和临床后果。随机临床试验表明，与口服或无铁相比，静脉铁在减少输血、增加血红蛋白和改善 ESA 治疗的贫血晚期癌症患者的生活质量方面具有更好的疗效。此外，应评估无额外 ESA 的静脉铁作为化疗引起的贫血患者的潜在治疗方法。在推荐剂量下，静脉铁耐受性良好，特别是与口服铁相比，但在某些特定情况下应谨慎使用。
