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Chang Lee R, Sukumaran S, Koczwara B, Woodman R, Kichenadasse G, Roy A, Vatandoust S, Karapetis C. Patterns of care in Jehovah's Witnesses patients with solid tumours and lymphoma. Cancer Rep (Hoboken) 2019; 2:e1148. [PMID: 32721085 DOI: 10.1002/cnr2.1148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Supportive care of Jehovah's Witnesses (JWs) diagnosed with cancer can be challenging, as they do not accept red blood cell (RBC) transfusions. AIM The study was designed to determine treatment preferences and pattern of care offered to JWs diagnosed with cancer and its impact on cancer management. METHODS AND RESULTS A retrospective cohort study of JWs with solid malignancies or lymphoma in our institution between 2005 and 2015 was conducted. Survival statistics were estimated using Kaplan Meier survival curves and Cox proportional regression model. A total of 63 JWs were identified with a median age of 70 years. At diagnosis, 34% (n = 22) had anaemia. All 63 declined RBC transfusion, including 19 patients who later developed transfusion threshold during anti-cancer treatment. Forty-three percent (n = 27) JWs had advanced (stage 4) disease, and 76% (n = 48) had Eastern Cooperative Oncology Group of 0 to 1. JWs were willing to accept surgery and radiation rather than chemotherapy. Treatment was deemed to be suboptimal in 22% (n = 14) JWs due to early treatment discontinuation, administration of non-standard chemotherapy regimen, or dose reduction due to anaemia and denial of blood transfusion. Twenty-seven percent (n = 17) received hematopoietic growth factors (erythropoiesis-stimulating agents and pegfilgrastim). There was no mortality directly attributed to anaemia or refusal of blood transfusion in the entire cohort. CONCLUSION Jehovah's Witnesses declined RBC transfusion at diagnosis and during cancer therapy even if medically indicated. Management pathways need to be prospectively defined for this group of patients.
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Affiliation(s)
| | - Shawgi Sukumaran
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | | | - Ganessan Kichenadasse
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Amitesh Roy
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Sina Vatandoust
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
| | - Chris Karapetis
- Flinders Medical Centre, FCIC, Bedford Park, SA, 5042, Australia.,Flinders University, Bedford Park, SA, 5042, Australia
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Madeddu C, Gramignano G, Astara G, Demontis R, Sanna E, Atzeni V, Macciò A. Pathogenesis and Treatment Options of Cancer Related Anemia: Perspective for a Targeted Mechanism-Based Approach. Front Physiol 2018; 9:1294. [PMID: 30294279 PMCID: PMC6159745 DOI: 10.3389/fphys.2018.01294] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 08/28/2018] [Indexed: 01/28/2023] Open
Abstract
Cancer-related anemia (CRA) is a common sign occurring in more than 30% of cancer patients at diagnosis before the initiation of antineoplastic therapy. CRA has a relevant influence on survival, disease progression, treatment efficacy, and the patients' quality of life. It is more often detected in patients with advanced stage disease, where it represents a specific symptom of the neoplastic disease, as a consequence of chronic inflammation. In fact, CRA is characterized by biological and hematologic features that resemble those described in anemia associated to chronic inflammatory disease. Proinflammatory cytokine, mainly IL-6, which are released by both tumor and immune cells, play a pivotal action in CRA etiopathogenesis: they promote alterations in erythroid progenitor proliferation, erythropoietin (EPO) production, survival of circulating erythrocytes, iron balance, redox status, and energy metabolism, all of which can lead to anemia. The discovery of hepcidin allowed a greater knowledge of the relationships between immune cells, iron metabolism, and anemia in chronic inflammatory diseases. Additionally, chronic inflammation influences a compromised nutritional status, which in turn might induce or contribute to CRA. In the present review we examine the multifactorial pathogenesis of CRA discussing the main and novel mechanisms by which immune, nutritional, and metabolic components affect its onset and severity. Moreover, we analyze the status of the art and the perspective for the treatment of CRA. Notably, despite the high incidence and clinical relevance of CRA, controlled clinical studies testing the most appropriate treatment for CRA are scarce, and its management in clinical practice remains challenging. The present review may be useful to indicate the development of an effective approach based on a detailed assessment of all factors potentially involved in the pathogenesis of CRA. This mechanism-based approach is essential for clinicians to plan a safe, targeted, and successful therapy, thereby promoting a relevant amelioration of patients' quality of life.
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Affiliation(s)
- Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Giorgio Astara
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Cagliari, Cagliari, Italy
| | - Roberto Demontis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Elisabetta Sanna
- Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Vinicio Atzeni
- Hospital Medical Management, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Antonio Macciò
- Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy
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3
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Xu H, Xu L, Page JH, Cannavale K, Sattayapiwat O, Rodriguez R, Chao C. Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013. Clin Epidemiol 2016; 8:61-71. [PMID: 27186078 PMCID: PMC4847604 DOI: 10.2147/clep.s89480] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to evaluate and characterize the risk of anemia during the course of chemotherapy among patients with five common types of solid tumors. Patients and methods Patients diagnosed with incident cancers of breast, lung, colon/rectum, stomach, and ovary who received chemotherapy were identified from Kaiser Permanente Southern California Health Plan (2010–2012). All clinical data were collected from the health plan’s electronic medical records. Incidence proportions of patients developing anemia and 95% confidence intervals were calculated overall and by anemia severity and type, as well as by stage at cancer diagnosis, and by chemotherapy regimen and cycle. Results A total of 4,426 patients who received chemotherapy were included. Across cancers, 3,962 (89.5%) patients developed anemia during the course of chemotherapy (normocytic 85%, macrocytic 10%, microcytic 5%; normochromic 47%, hyperchromic 44%, hypochromic 9%). The anemia grades were distributed as follows: 58% were grade 1, 34% grade 2, 8% grade 3, and <1% grade 4. The incidence of grade 2+ anemia ranged from 26.3% in colorectal cancer patients to 59.2% in ovarian cancer patients. Incidence of grade 2+ anemia increased from 29% in stage I to 49% in stage IV. Incidence of grade 2+ anemia varied from 18.2% in breast cancer patients treated with cyclophosphamide + docetaxel regimen to 59.7% in patients with ovarian cancer receiving carboplatin + paclitaxel regimen. Conclusion The incidence of moderate-to-severe anemia (hemoglobin <10 g/dL) remained considerably high in patients with solid tumors receiving chemotherapy. The risk of anemia was greater in patients with distant metastasis.
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Affiliation(s)
- Hairong Xu
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Lanfang Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John H Page
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Kim Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Olivia Sattayapiwat
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Roberto Rodriguez
- Department of Hematology Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Psadena, CA, USA
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Zhang Q, Yang J, Qian Q. Evidence-based treatment of patients with rectal cancer. Oncol Lett 2016; 11:1631-1634. [PMID: 26998054 PMCID: PMC4774437 DOI: 10.3892/ol.2016.4100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/11/2016] [Indexed: 01/15/2023] Open
Abstract
Rectal cancer is a worldwide disease whose incidence has increased significantly. Evidence-based medicine is a category of medicine that optimizes decision making by using evidence from well-designed and conducted research. Evidence-based medicine can be used to formulate a reasonable treatment plan for newly diagnosed rectal cancer patients. The current review focuses on the application of evidence-based treatment on patients with rectal cancer. The relationship between perioperative blood transfusion and recurrence of rectal cancer after surgery, the selection between minimally invasive laparoscopic surgery and traditional laparotomy, choice of chemotherapy for patients with rectal cancer prior to surgery, selection between stapled and hand-sewn methods for colorectal anastomosis during rectal cancer resection, and selection between temporary ileostomy and colostomy during the surgery were addressed. Laparoscopy is considered to have more advantages but is time-consuming and has high medical costs. In addition, laparoscopic rectal cancer radical resection is preferred to open surgery. In radical resection surgery, use of a stapling device for anastomosis can reduce postoperative anastomotic fistula, although patients should be informed of possible anastomotic stenosis.
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Affiliation(s)
- Qiang Zhang
- Department of General Surgery, Xiangyang Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Jie Yang
- Department of General Surgery, Xiangyang Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Qun Qian
- Department of General Surgery, Xiangyang Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
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Xu L, Xu H, Cannavale K, Sattayapiwat O, Rodriguez R, Page JH, Chao C. Trends in anemia treatment among patients with five non-myeloid malignancies treated with chemotherapy in a large integrated health care delivery system in California, 2000–2013. Support Care Cancer 2016; 24:2989-98. [DOI: 10.1007/s00520-016-3078-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/03/2016] [Indexed: 11/30/2022]
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Nagarsheth NP, Gupta N, Gupta A, Moshier E, Gretz H, Shander A. Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service. J Blood Med 2015; 6:17-23. [PMID: 25565911 PMCID: PMC4284050 DOI: 10.2147/jbm.s70981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives To review the responses of advance directives signed by Jehovah’s Witness patients prior to undergoing surgery at a gynecologic oncology service. Study design A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998–2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients. Results No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (P<0.0001). In addition, all gynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (P<0.0001). Conclusion Our results confirm the commonly held belief that the majority of Jehovah’s Witness patients refuse to accept major blood components. However, Jehovah’s Witness patients at a gynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service.
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Affiliation(s)
- Nimesh P Nagarsheth
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA ; Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Nikhil Gupta
- Department of Urology, North Shore - Long Island Jewish Health Service, New Hyde Park, NY, USA
| | - Arpeta Gupta
- Department of Endocrinology, Diabetes and Metabolism, St Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - Erin Moshier
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA
| | - Herbert Gretz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA
| | - Aryeh Shander
- Department of Anesthesiology, Englewood Hospital and Medical Center, Englewood, NJ, USA
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Xu H, Kaye JA, Saltus CW, Crawford J, Gasal E, Goodnough LT. Blood utilization and hemoglobin levels in cancer patients after label and coverage changes for erythropoiesis-stimulating agents. Expert Rev Hematol 2014; 7:617-33. [DOI: 10.1586/17474086.2014.943730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Erythropoietin-stimulating agents and clinical outcomes in metastatic breast cancer patients with chemotherapy-induced anemia: a closed debate? Tumour Biol 2014; 35:5095-100. [DOI: 10.1007/s13277-014-1730-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022] Open
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Erythropoietin treatment in chemotherapy-induced anemia in previously untreated advanced esophagogastric cancer patients. Int J Clin Oncol 2013; 19:288-96. [PMID: 23532629 DOI: 10.1007/s10147-013-0544-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/17/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The impact of erythropoiesis-stimulating agents in chemotherapy-induced anemia has been a constant topic of debate over recent years. We prospectively assessed the efficacy of epoetin beta (Epo-b) in improving hemoglobin (Hb) levels and outcome in patients within an open label, randomized clinical phase II trial with advanced or metastatic gastric/esophagogastric cancer. METHODS Previously untreated patients were randomized to receive 3-weekly cycles of capecitabine (1000 mg/m(2) bid) for 14 days plus on day 1 either irinotecan 250 mg/m(2) or cisplatin 80 mg/m(2). Epo-b (30000 IU once weekly) was initiated in patients with Hb <11 g/dl and continued until Hb ≥12 g/dl was reached. If after 4 weeks the Hb increase was <0.5 g/dl, Epo-b was increased to 30000 IU, twice weekly. RESULTS Of 118 patients enrolled, 32 received Epo-b treatment; of these, 65 % achieved an increase in Hb levels of at least 2 g/dl, with 74 % achieving the target Hb of ≥12 g/dl. Within the study population, patients receiving Epo-b showed better overall survival (median 14.5 vs. 8.0 months, P = 0.056) as well as a significantly improved disease control rate (78 vs. 55 %, P = 0.025). Patients in the irinotecan group profited significantly (P < 0.05) in terms of progression-free survival and overall survival under Epo-b treatment (median 6.5 vs 4.1 months and median 15.4 vs 8.4 months, respectively). CONCLUSIONS Epo-b was effective in raising Hb levels in patients with advanced esophagogastric cancer. Patients receiving Epo-b had a significantly increased response to chemotherapy and a clear trend to improved survival.
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Skoog K, Carmelle-Elie M, Ferguson K. Mesenteric infarction due to iatrogenic polycythemia. World J Emerg Med 2013; 4:232-4. [PMID: 25215125 PMCID: PMC4129844 DOI: 10.5847/wjem.j.issn.1920-8642.2013.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 06/01/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count. There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia. METHODS: We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit. The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from unmonitored procrit, which lead to hyperviscosity of blood and mesenteric infarction. RESULTS: The patient remained intubated with ventilator support. He refused a tracheostomy. He continued on feeding through the J port of the nasojejunal tube. His white cell count, and hematocrit and creatinine levels remained normal. Procrit use and chemotherapy were not restarted. He was transferred to a subacute nursing facility for further treatment. CONCLUSIONS: Procrit and other erythropoiesis stimulating drugs can cause significant morbidity and mortality with an increased risk of cardiovascular events, gastrointestinal bleeding, thromboembolism and stroke. This case report suggests that without closely monitoring hematocrit levels, epoetin may also be associated with an increased risk of mesenteric infarction.
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Affiliation(s)
- Katrina Skoog
- University of Florida School of Medicine, Gainesville, FL, USA
| | | | - Kevin Ferguson
- University of Florida School of Medicine, Gainesville, FL, USA
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Stroupe KT, Tarlov E, Lee TA, Weichle TW, Zhang QL, Michaelis LC, Ozer H, Durazo-Arvizu R, Browning MM, Hynes DM. Hemoglobin Levels Triggering Erythropoiesis-Stimulating Agent Therapy in Patients with Cancer: the Shift After United States Food and Drug Administration Policy Changes. Pharmacotherapy 2012; 32:988-97. [DOI: 10.1002/phar.1134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kevin T. Stroupe
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
- Stritch School of Medicine; Loyola University Chicago; Maywood Illinois
| | - Elizabeth Tarlov
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
| | - Todd A. Lee
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Thomas W. Weichle
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
| | - Qiuying L. Zhang
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
| | | | - Howard Ozer
- College of Medicine; University of Illinois at Chicago; Chicago Illinois
| | | | - Margaret M. Browning
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
| | - Denise M. Hynes
- Center for Management of Complex Chronic Care; Hines VA Hospital; Hines Illinois
- Veterans Affairs Information Resource Center (K.T. Stroupe, E. Tarlov, M.M. Browning, and D.M. Hynes); Hines Veterans Affairs Hospital; Hines Illinois
- College of Medicine; University of Illinois at Chicago; Chicago Illinois
- Institute for Health Research and Policy (D.M. Hynes); University of Illinois at Chicago; Chicago Illinois
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12
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Mortimer J. Elderly studies of anemia (ESAs) needed. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Gündüz E, Gülbaş Z. Supportive care in hemato-oncology: a review in light of the latest guidelines. Turk J Haematol 2012; 29:1-9. [PMID: 24744617 PMCID: PMC3986760 DOI: 10.5505/tjh.2012.10327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 05/17/2011] [Indexed: 11/09/2022] Open
Abstract
Recent developments in cancer therapy have resulted in increases in treatment success rates and survival. One of thebasic goals of such therapy is improving patient quality of life. Chemotherapy protocols for solid or hematologicalmalignancies-most of which include multiple agents-negatively impact patient quality of life. Additionally, there havebeen developments in supportive care, which seeks to ameliorate or minimize the negative effects of chemotherapy.Herein we present a review and brief summarization of some of the agents used for supportive care in cancer patientsin light of the latest guidelines.
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Affiliation(s)
- Eren Gündüz
- Eskişehir Osmangazi University, School of Medicine, Department of Hematology, Eskişehir, Turkey
| | - Zafer Gülbaş
- Anadolu Health Center, Bone Marrow Transplantation Center, Kocaeli, Turkey
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Hurria A, Browner IS, Cohen HJ, Denlinger CS, deShazo M, Extermann M, Ganti AKP, Holland JC, Holmes HM, Karlekar MB, Keating NL, McKoy J, Medeiros BC, Mrozek E, O'Connor T, Petersdorf SH, Rugo HS, Silliman RA, Tew WP, Walter LC, Weir AB, Wildes T. Senior adult oncology. J Natl Compr Canc Netw 2012; 10:162-209. [PMID: 22308515 PMCID: PMC3656650 DOI: 10.6004/jnccn.2012.0019] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Ribatti D. Angiogenic Effects of Erythropoietin. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2012; 299:199-234. [DOI: 10.1016/b978-0-12-394310-1.00005-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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16
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Randomised, phase III trial of epoetin-β to treat chemotherapy-induced anaemia according to the EU regulation. Br J Cancer 2011; 105:1267-72. [PMID: 21959870 PMCID: PMC3241560 DOI: 10.1038/bjc.2011.395] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Erythropoietin-stimulating agents (ESAs) effectively decrease the transfusion requirements of patients with chemotherapy-induced anaemia (CIA). Recent studies indicate that ESAs increase mortality and accelerate tumour progression. The studies also identify a 1.6-fold increased risk of venous thromboembolism. The ESA labelling was thus revised in Europe and the United States in 2008. This is the first randomised, phase III trial evaluating the efficacy and safety of epoetin-β (EPO), an ESA, dosed in accordance with the revised labelling, which specifies that ESAs should be administered to CIA patients with a haemoglobin level of ⩽10 g dl–1 and that a sustained haemoglobin level of >12 g dl–1 should be avoided. Methods: A total of 186 CIA patients (8.0 g dl–1⩽ haemoglobin ⩽10.0 g dl–1) with lung or gynaecological cancer were randomised to receive EPO 36 000 IU or placebo weekly for 12 weeks. Results: The proportion of patients receiving transfusions or with haemoglobin <8.0 g dl–1 between week 5 and the end of the treatment period as the primary end point was significantly lower in the EPO group (n=89) than in the placebo group (n=92; 10.0% vs 56.4%, P<0.001). The proportion receiving transfusions was significantly lower in the EPO group (4.5% vs 19.6%, P=0.002). Changes in quality of life were not different. No significant differences in adverse events – for example, the incidence of thromboembolic events was 1.1% for each group – or the 1-year overall survival were observed between groups. Conclusion: Weekly EPO administered according to the revised labelling approved by the European Medicines Agency is effective and well tolerated for CIA treatment. Further investigations are needed on the effect of ESAs on mortality.
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Welsch T, Zschäbitz S, Becker V, Giese T, Bergmann F, Hinz U, Keleg S, Heller A, Sipos B, Klingmüller U, Büchler MW, Werner J, Giese NA. Prognostic significance of erythropoietin in pancreatic adenocarcinoma. PLoS One 2011; 6:e23151. [PMID: 21829709 PMCID: PMC3148251 DOI: 10.1371/journal.pone.0023151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/07/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Erythropoietin (Epo) administration has been reported to have tumor-promoting effects in anemic cancer patients. We investigated the prognostic impact of endogenous Epo in patients with pancreatic ductal adenocarcinoma (PDAC). METHODOLOGY The clinico-pathological relevance of hemoglobin (Hb, n = 150), serum Epo (sEpo, n = 87) and tissue expression of Epo/Epo receptor (EpoR, n = 104) was analyzed in patients with PDAC. Epo/EpoR expression, signaling, growth, invasion and chemoresistance were studied in Epo-exposed PDAC cell lines. RESULTS Compared to donors, median preoperative Hb levels were reduced by 15% in both chronic pancreatitis (CP, p<0.05) and PDAC (p<0.001), reaching anemic grade in one third of patients. While inversely correlating to Hb (r = -0.46), 95% of sEPO values lay within the normal range. The individual levels of compensation were adequate in CP (observed to predicted ratio, O/P = 0.99) but not in PDAC (O/P = 0.85). Strikingly, lower sEPO values yielding inadequate Epo responses were prominent in non-metastatic M0-patients, whereas these parameters were restored in metastatic M1-group (8 vs. 13 mU/mL; O/P = 0.82 vs. 0.96; p<0.01)--although Hb levels and the prevalence of anemia were comparable. Higher sEpo values (upper quartile ≥ 16 mU/ml) were not significantly different in M0 (20%) and M1 (30%) groups, but were an independent prognostic factor for shorter survival (HR 2.20, 10 vs. 17 months, p<0.05). The pattern of Epo expression in pancreas and liver suggested ectopic release of Epo by capillaries/vasa vasorum and hepatocytes, regulated by but not emanating from tumor cells. Epo could initiate PI3K/Akt signaling via EpoR in PDAC cells but failed to alter their functions, probably due to co-expression of the soluble EpoR isoform, known to antagonize Epo. CONCLUSION/SIGNIFICANCE Higher sEPO levels counteract anemia but worsen outcome in PDAC patients. Further trials are required to clarify how overcoming a sEPO threshold ≥16 mU/ml by endogenous or exogenous means may predispose to or promote metastatic progression.
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Affiliation(s)
- Thilo Welsch
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Verena Becker
- Division Systems Biology of Signal Transduction, German Cancer Research Center and Bioquant, Heidelberg University, Heidelberg, Germany
| | - Thomas Giese
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Frank Bergmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Shereen Keleg
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Heller
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Bence Sipos
- Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Ursula Klingmüller
- Division Systems Biology of Signal Transduction, German Cancer Research Center and Bioquant, Heidelberg University, Heidelberg, Germany
| | - Markus W. Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Nathalia A. Giese
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Risk management of biosimilars in oncology. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Richardson P, Schlag R, Khuageva N, Dimopoulos M, Shpilberg O, Kropff M, Vekemans MC, Petrucci MT, Rossiev V, Hou J, Robak T, Mateos MV, Anderson K, Esseltine DL, Cakana A, Liu K, Deraedt W, van de Velde H, San Miguel JF. Characterization of haematological parameters with bortezomib-melphalan-prednisone versus melphalan-prednisone in newly diagnosed myeloma, with evaluation of long-term outcomes and risk of thromboembolic events with use of erythropoiesis-stimulating agents: analysis of the VISTA trial. Br J Haematol 2011; 153:212-21. [PMID: 21375521 DOI: 10.1111/j.1365-2141.2011.08569.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although haematological toxicities, such as anaemia, are common in multiple myeloma (MM), no clear consensus exists on the use and impact of erythropoiesis-stimulating agents (ESA) on outcomes in MM. This analysis characterizes haematological toxicities and associated interventions in the phase III VISTA (Velcade(®) as Initial Standard Therapy in Multiple Myeloma: Assessment with Melphalan and Prednisone) study of bortezomib plus melphalan/prednisone (VMP, n = 344) versus MP (n = 338) in previously untreated MM patients ineligible for high-dose therapy, and evaluates the impact of ESA use or red-blood-cell (RBC) transfusions on outcomes and thromboembolic risk. Incidence of haematological toxicities was similar with VMP and MP; similar rates of interventions and associated complications (e.g. bleeding, febrile neutropenia) were observed. Two hundred thirty three patients received ESA; 204 had RBC transfusions. Frequency of thromboembolic events was low and not affected by ESA use. Median time-to progression (TTP) was similar between ESA/non-ESA [hazard ratio: 1·03 (95% confidence interval 0·76-1·39); P = 0·8478] in both arms (VMP: 19·9/not reached; MP: 15·0/17·5 months). Three-year overall survival (OS) rates were similar between ESA/non-ESA in each arm. Patients receiving RBC transfusions had significantly shorter OS (P < 0·0001) versus non-RBC-transfusion patients. In conclusion, bortezomib did not add to melphalan haematological toxicity. Concomitant ESA use with VMP/MP in previously untreated MM patients did not adversely affect TTP or OS, or increase thromboembolic risk. However, RBC transfusion was associated with significantly shorter survival.
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Affiliation(s)
- Paul Richardson
- Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA.
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Vadhan-Raj S, Zhou X, Sizer K, Lal L, Wang X, Roquemore J, Shi W, Benjamin RS, Lichtiger B. Impact of safety concerns and regulatory changes on the usage of erythropoiesis-stimulating agents and RBC transfusions. Oncologist 2010; 15:1359-69. [PMID: 21159724 DOI: 10.1634/theoncologist.2010-0293] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Safety concerns raised in the recent oncology trials with erythropoiesis-stimulating agents (ESAs) have led to regulatory restrictions on their use. We wished to determine the impact of these changes on the use of ESAs and RBC transfusions. METHODS In a retrospective observational study of patients treated at a comprehensive cancer center in 2006-2008, data on all ESA doses dispensed, RBCs transfused, and hemoglobin levels on the days of transfusions and ESA initiations were analyzed. RESULTS Compared with 2006, the total patients treated was 14% higher (28,339 versus 24,806) in 2007 and 22% higher (30,254) in 2008. Patients receiving ESAs decreased by 26% and 61%, and ESA units dispensed decreased by 29% (from 30,206 units to 21,409 units) and 80% (6,102 units) in 2007 and 2008, respectively. However, RBC transfusions increased by only 2% (from 38,218 units to 38,948 units) in 2007 and by 8% (41,438) in 2008. The mean hemoglobin on the day of transfusion was the same for each year (8.4 g/dl); however, an increasing proportion of patients initiated ESAs at lower hemoglobin (< 10 g/dl) levels. After adjusting for demographics and diagnostic variables for 3 years (n = 83,399), a multivariate logistic regression showed a significant decline in ESA use (p < .0001) without an increase in RBC transfusions. CONCLUSIONS Recent ESA safety concerns and regulatory restrictions have significantly decreased ESA use. The lack of a significant impact on transfusions may be related to a lower hemoglobin threshold used to initiate ESAs or treatment of patients less likely to respond.
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Affiliation(s)
- Saroj Vadhan-Raj
- Department of Sarcoma Medical Oncology, Section of Cytokines and Supportive Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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21
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Platek ME, Reid ME, Wilding GE, Jaggernauth W, Rigual NR, Hicks WL, Popat SR, Warren GW, Sullivan M, Thorstad WL, Khan MK, Loree TR, Singh AK. Pretreatment nutritional status and locoregional failure of patients with head and neck cancer undergoing definitive concurrent chemoradiation therapy. Head Neck 2010; 33:1561-8. [PMID: 21990220 DOI: 10.1002/hed.21640] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2010] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study was carried out to determine if markers of nutritional status predict for locoregional failure following intensity-modulated radiation therapy (IMRT) with concurrent chemoradiotherapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN). METHODS We performed a retrospective chart review of 78 patients with SCCHN who received definitive CCRT. We compared patient factors, tumor characteristics, and nutritional status indicators between patients with and without locoregional failure. RESULTS Fifteen of 78 patients (19%) experienced locoregional failure. Median follow-up for live patients was 38 months. On univariate analysis, pretreatment percentage of ideal body weight (%IBW) (p < .01), pretreatment hemoglobin (p = .04), and treatment duration (p < .01) were significant predictors of failure. On multivariate analysis, pretreatment %IBW (p = .04) and treatment time (p < .01) remained statistically significant. CONCLUSIONS Although treatment time is an accepted risk factor for failure, differences in outcome for patients with head and neck cancer undergoing definitive CCRT based on pretreatment %IBW should be examined further.
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Affiliation(s)
- Mary E Platek
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, USA.
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The preoperative use of erythropoietin stimulating proteins prior to radical prostatectomy is not associated with increased cardiovascular or thromboembolic morbidity or mortality. Urology 2010; 75:1424-8. [PMID: 20513505 DOI: 10.1016/j.urology.2009.06.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 06/05/2009] [Accepted: 06/13/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To critically examine the cardiovascular and thromboembolic risks associated with erythropoietin stimulating proteins (ESPs) in men with normal hemoglobin levels undergoing open radical retropubic prostatectomy. METHODS Between October 1, 2000, through December 31, 2006, a total of 1308 men underwent open radial retropubic prostatectomy by a single surgeon. Of these men, 1095 received preoperative ESPs. Hematocrit levels measured at baseline, immediately before anesthesia induction and at hospital discharge, were prospectively entered into a database. Thromboembolic and cardiovascular complications were prospectively captured during the hospitalization and after surgery. RESULTS The mean Delta preoperative hematocrit level was 5.9 g/dL. The pre-anesthesia induction hematocrit level was 49.2%. Hospital discharge hematocrit level was 33.6 g/dL. The overall risk of cardiovascular and thromboembolic complications in men receiving ESP were 0.55% and 0.45%, respectively. The risk of cardiovascular and thromboembolic complications were independent of the Delta in preoperative hematocrit or the absolute level of the pre-anesthesia induction hematocrit. CONCLUSIONS ESPs represent a safe and effective preoperative blood management strategy for men undergoing open radical retropubic prostatectomy.
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Bernaudin M, Bianchi R, Blomgren K, Brines M, Campana W, Cavaletti G, Cerami A, Chopp M, Coleman T, Digicaylioglu M, Ehrenreich H, Erbayraktar S, Erbayraktar Z, Gassmann M, Genc S, Ghezzi P, Gokmen N, Grasso G, Juul S, Lipton SA, Hand CC, Latini R, Lauria G, Leist M, Newton SS, Petit E, Probert L, Sfacteria A, Siren AL, Talan M, Thiemermann C, Westenbrink D, Yaqoob M, Zhu C. Erythropoietin: not just about erythropoiesis. Lancet 2010; 375:2142. [PMID: 20609950 PMCID: PMC4894326 DOI: 10.1016/s0140-6736(10)60992-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Myriam Bernaudin
- CERVOxy group, UMR CI-NAPS 6232, CNRS, CEA, University of Caen Basse-Normandie, Centre Cyceron, Bd H. Becquerel, BP 5229, F-14074 Caen cedex, France
| | - Roberto Bianchi
- Neuromuscular Diseases Unit, “Carlo Besta” Neurological Institute, 20133, Milan, Italy
| | - Klas Blomgren
- Institute of Neuroscience and Physiology, University of Gothenburg, SE 41390 Gothenburg, Sweden
| | | | - Wendy Campana
- School of Medicine, University of California, San Diego, La Jolla, CA 92093-0629, USA
| | - Guido Cavaletti
- Dip. Neuroscienze e Tecnologie Biomediche - Università di Milano “Bicocca”, 20052 Monza (MI) - Italy
| | - Anthony Cerami
- Leiden University Medical School, Leiden 2300RC, Netherlands
| | - Michael Chopp
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202
| | - Thomas Coleman
- Feinstein Institute for Medical Research, Manhasset, New York 11030
| | - Murat Digicaylioglu
- Department of Neurosurgery, University of Texas, Health Science Center, San Antonio, TX, 78229-3900
| | - Hannelore Ehrenreich
- Division Klinische Neurowissenschaften, Max-Planck-Institut für Experimentelle Medizin, 37075 Göttingen
| | | | | | - Max Gassmann
- Institute of Veterinary Physiology, University of Zürich, CH-8057 Zürich
| | - Sermin Genc
- Department of Medical Biology and Genetics, School of Medicine, Dokuz Eylul University, Inciralti, 35340, Izmir, Turkey
| | - Pietro Ghezzi
- Brighton & Sussex Medical School, Falmer, BN1 9RY, United Kingdom
| | - Necati Gokmen
- Dokuz Eylul University, Inciralti, 35340, Izmir, Turkey
| | - Giovanni Grasso
- Department of Clinical Neurosciences, University of Palermo, 90100 Palermo, Italy
| | - Sandra Juul
- University of Washington Seattle, WA 98195-6320
| | - Stuart A. Lipton
- Sanford-Burnham Medical Research Institute, Salk Institute for Biological Studies, The Scripps Research Institute, and the University of California, San Diego. La Jolla, CA 92037, USA
| | - Carla Cerami Hand
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435
| | - Roberto Latini
- Dept Cardiovascular Research, Istituto Mario Negri, 20156 Milan, Italy
| | - Giuseppe Lauria
- Neuromuscular Diseases Unit, “Carlo Besta” Neurological Institute, 20133, Milan, Italy
| | - Marcel Leist
- University of Konstanz, Box M657, D- 78457 Konstanz, Germany
| | | | - Edwige Petit
- CERVOxy group, UMR CI-NAPS 6232, CNRS, CEA, University of Caen Basse-Normandie, Centre Cyceron, Bd H. Becquerel, BP 5229, F-14074 Caen cedex, France
| | - Lesley Probert
- Laboratory of Molecular Genetics, Hellenic Pasteur Institute, 11521 Athens, Greece
| | | | - Anna-Leena Siren
- Neurochirurgische Klinik und Poliklinik der Universität Würzburg, 97080 Würzburg, Germany
| | - Mark Talan
- Laboratory of Cardiovascular Sciences, National Institute on Aging, Baltimore, MD 21224-6825, USA
| | - Chris Thiemermann
- William Harvey Research Institute, Charterhouse Square, London EC1M 6BQ, UK
| | | | - Magdi Yaqoob
- William Harvey Research Institute, Charterhouse Square, London EC1M 6BQ, UK
| | - Changlian Zhu
- Department of Pediatrics, The Third Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
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Szenajch J, Wcislo G, Jeong JY, Szczylik C, Feldman L. The role of erythropoietin and its receptor in growth, survival and therapeutic response of human tumor cells From clinic to bench - a critical review. Biochim Biophys Acta Rev Cancer 2010; 1806:82-95. [PMID: 20406667 DOI: 10.1016/j.bbcan.2010.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/05/2010] [Accepted: 04/11/2010] [Indexed: 12/27/2022]
Abstract
Recombinant human erythropoietin (rhEPO) has been used clinically to alleviate cancer- and chemotherapy-related anemia. However, recent clinical trials have reported that rhEPO also may adversely impact disease progression and survival. The expression of functional EPO receptors (EPOR) has been demonstrated in many human cancer cells where, at least in vitro, rhEPO can stimulate cell growth and survival and may induce resistance to selected therapies. Responses to rhEPO measured by alterations in tumor cell growth or survival, activation of signaling pathways or modulation of sensitivity to anticancer agents are variable. Both methodological and inherent biological issues underlie the differential cell responses, including reported difficulties in EPOR protein detection, potential involvement of EPOR isoforms or of cytoplasmic EPOR, possible differential structure and/or binding affinities of hematopoietic versus non-hematopoietic cell EPOR, possible aberrant regulation of EPOR activity, and a functional EPO/EPOR autocrine/paracrine loop. The modulation by rhEPO of tumor cell response to anticancer agents is coincident with modulation of multiple signaling pathways, BCL-2 family proteins, caspases and NFkB. The molecular interplay of pro-survival and pro-death signals, triggered by EPO and/or by anticancer agents, is multifactorial and tightly coordinated. Expression microarray analysis may prove critical for deciphering this potentially novel network and its broad spectrum of genes and proteins.
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Affiliation(s)
- Jolanta Szenajch
- Laboratory for Molecular Oncology, Military Institute of Medicine, Warsaw, Poland
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Abstract
Erythropoietin (Epo) may be considered as an endogenous stimulator of vessel growth during tumor progression through an autocrine and/or paracrine loop. The vascular effects of Epo would be relevant in tumor angiogenesis and the negative effect of Epo on tumor growth may be aggravated by its angiogenic activity. The mechanism of tumor growth in the context of Epo is not completely clarified, and it is still not clear whether there is a direct effect of Epo in tumor cells as opposed to exogenous effect on angiogenesis. It is also possible that the effect of Epo is multifactorial depending on the type of tumor and level of functionality of Epo receptor expression in tumor cells, as well other variables such as hypoxic stress, degree of anemia, chemotherapy, radiotherapy of surgical intervention.
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Affiliation(s)
- Domenico Ribatti
- Department of Human Anatomy and Histology, University of Bari Medical School, Bari, Italy.
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Lal LS, Raju A, Miller LA, Chen H, Arbuckle R, Sansgiry SS. Impact of changes in reimbursement policies and institutional practice algorithm for utilization of erythropoietic-stimulating agents on treatment patterns and costs in anemic lymphoma patients. Support Care Cancer 2010; 19:251-9. [PMID: 20101414 DOI: 10.1007/s00520-009-0811-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Lincy Subha Lal
- Division of Pharmacy, Unit 90, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Nagarsheth NP, Sasan F. Bloodless Surgery in Gynecologic Oncology. ACTA ACUST UNITED AC 2009; 76:589-97. [DOI: 10.1002/msj.20146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care*. Crit Care Med 2009; 37:3124-57. [DOI: 10.1097/ccm.0b013e3181b39f1b] [Citation(s) in RCA: 364] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Paragh G, Kumar SM, Rakosy Z, Choi SC, Xu X, Acs G. RNA interference-mediated inhibition of erythropoietin receptor expression suppresses tumor growth and invasiveness in A2780 human ovarian carcinoma cells. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 174:1504-14. [PMID: 19264915 DOI: 10.2353/ajpath.2009.080592] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although recombinant human erythropoietin (rHuEpo) has revolutionized the treatment of anemia, recent clinical trials suggested that rHuEpo use may be associated with decreased survival in cancer patients. Although the expression of erythropoietin (Epo) receptor (EpoR) has been demonstrated in various human cancers, the effect of exogenous Epo on the growth and therapy resistance of EpoR-bearing tumor cells is unclear at present. In the current study, we examined the hypothesis that EpoR may contribute to tumor growth independent of Epo in A2780 human ovarian carcinoma cells. A2780 human ovarian carcinoma cells showed high levels of EpoR expression, but lacked expression of Epo mRNA and biologically active Epo protein under both normoxic and hypoxic conditions. Exogenous Epo did not stimulate EpoR-mediated signaling, proliferation, invasiveness, or resistance to cytotoxic drugs in A2780 cells. In contrast, specific inhibition of EpoR expression using a short hairpin RNA (shRNA) expression plasmid resulted in markedly reduced proliferation and invasiveness in vitro. In addition, inhibition of EpoR expression led to abrogated in vivo ovarian cancer cell growth in a tumor xenograft system and resulted in decreased EpoR signaling. Our findings suggest that EpoR may be constitutively active in some cancer cells in the absence of Epo and provide the first evidence for a potential role of an Epo-independent, EpoR-mediated pathway in the growth of some human cancers.
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Affiliation(s)
- Gyorgy Paragh
- Experimental Therapeutics Program, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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