1
|
Bowling GC, Swargaloganathan P, Heintz C, Madan RA, Eldhose B, Dobi A, Chesnut GT. Hematological Toxicities with PARP Inhibitors in Prostate Cancer: A Systematic Review and Meta-Analysis of Phase II/III Randomized Controlled Trials. Cancers (Basel) 2023; 15:4904. [PMID: 37835597 PMCID: PMC10571760 DOI: 10.3390/cancers15194904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Poly ADP-ribose polymerase inhibitors (PARPis) are an important class of therapeutics for metastatic castration-resistant prostate cancer (mCRPC). Unlike hormone-based treatments for mCRPC, PARPis are not without drug-related hematological adverse events. OBJECTIVE To review the evidence on hematological toxicities, including anemia, thrombocytopenia, and neutropenia from PARPis in prostate cancer. STUDY METHODOLOGY A systematic review and meta-analysis using the PRISMA guidelines was performed for phase II and III randomized controlled trials (RCTs) of PARPis in prostate cancer. PubMed, Embase, and Ovid All EBM reviews-Cochrane were queried from inception to 9 June 2023. The Mantel-Haenszel method was used to report risk ratios (RR) and 95% confidence intervals (CI) for all-grade and high-grade anemia, thrombocytopenia, and neutropenia toxicities. RESULTS The systematic review retrieved eight phase II and III RCTs; specifically, eight were included in the anemia, five in the all-grade thrombocytopenia and neutropenia, and four in the high-grade thrombocytopenia and neutropenia outcomes. Compared to a placebo and/or other non-PARPi treatments, PARPi use was associated with an increased risk of all-grade anemia (RR, 3.37; 95% CI, 2.37-4.79; p < 0.00001), thrombocytopenia (RR, 4.54; 95% CI, 1.97-10.44; p = 0.0004), and neutropenia (RR, 3.11; 95% CI, 1.60-6.03; p = 0.0008). High-grade anemia (RR, 6.94; 95% CI, 4.06-11.86; p < 0.00001) and thrombocytopenia (RR, 5.52; 95% CI, 2.80-10.88; p < 0.00001) were also associated with an increased risk, while high-grade neutropenia (RR, 3.63; 95% CI, 0.77-17.23; p = 0.10) showed no significant association. Subgroup stratification analyses showed differences in various all-grade and high-grade toxicities. CONCLUSION PARPis were associated with an increased risk of hematological AEs. Future studies with more pooled RCTs will enhance this understanding and continue to inform patient-physician shared decision-making. Future studies may also have a role in improving the current management strategies for these AEs.
Collapse
Affiliation(s)
- Gartrell C. Bowling
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
| | | | - Carly Heintz
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
| | - Ravi A. Madan
- Genitourinary Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Binil Eldhose
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Albert Dobi
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Gregory T. Chesnut
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Urology Service, Walter Reed National Medical Center, Bethesda, MD 20814, USA
| |
Collapse
|
2
|
Bekes I, Eichler M, Singer S, Friedl TWP, Harbeck N, Rack B, Forstbauer H, Dannecker C, Huober J, Kiechle M, Lato K, Janni W, Fink V. Impact of Granulocyte Colony-Stimulating Factor (G-CSF) and Epoetin (EPO) on Hematologic Toxicities and Quality of Life in Patients During Adjuvant Chemotherapy in Early Breast Cancer: Results From the Multi-Center Randomized ADEBAR Trial. Clin Breast Cancer 2020; 20:439-447. [PMID: 32800493 DOI: 10.1016/j.clbc.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hematologic toxicities are one of the greatest challenges in adjuvant chemotherapy for breast cancer. This analysis of the ADEBAR trial aims to evaluate application and effect of granulocyte colony-stimulating factor (G-CSF) and epoetin alfa (EPO) on hematologic parameters and fatigue in patients with breast cancer during chemotherapy. PATIENTS AND METHODS In the ADEBAR trial, 1493 patients with node-positive primary breast cancer were randomized to either 6 × 5-fluorouracil, epirubicin, and cyclophosphamide (FEC120) or 4 × epirubicin and cyclophosphamide followed by 4 × docetaxel (EC-DOC). Co-medication with G-CSF or EPO was applied to treat chemotherapy-induced leukopenia or anemia. Fatigue was assessed at baseline and after one-half of the chemotherapy. RESULTS In total, 899 patients could be included in the analysis. There was no evidence for an association between leucocyte or hemoglobin levels and application of G-CSF and EPO in the preceding cycle, respectively. Hemoglobin levels (B = -0.41; P < .001) were affected by treatment regimen. Fatigue during chemotherapy was mostly affected by the level of fatigue before the start of chemotherapy (B = 0.41; P < .001). Patients with G-CSF application in the preceding cycle showed an increased fatigue score (B = 5.43; P = .02). CONCLUSION We showed that fatigue during adjuvant chemotherapy was mostly affected by the level of fatigue present before the start of chemotherapy. This result suggests that the level of fatigue before the start of treatment should be included as an important factor when deciding on type and toxicity of chemotherapy in early breast cancer.
Collapse
Affiliation(s)
- Inga Bekes
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Martin Eichler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Susanne Singer
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Nadia Harbeck
- Breast Cancer Center, Department of Obstetrics and Gynecology, University of Munich, Munich, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Helmut Forstbauer
- Hemato-Oncological Practice Dres Forstbauer and Ziske, Troisdorf, Germany
| | - Christian Dannecker
- Department of Gynecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Krisztian Lato
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| |
Collapse
|
3
|
Ballo O, Fleckenstein P, Eladly F, Kreisel EM, Stratmann J, Seifried E, Müller M, Serve H, Bug G, Bonig H, Brandts CH, Finkelmeier F. Reducing the red blood cell transfusion threshold from 8·0 g/dl to 7·0 g/dl in acute myeloid leukaemia patients undergoing induction chemotherapy reduces transfusion rates without adversely affecting patient outcome. Vox Sang 2020; 115:570-578. [PMID: 32342521 DOI: 10.1111/vox.12919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Red blood cell (RBC) transfusions are needed by almost every acute myeloid leukaemia (AML) patient undergoing induction chemotherapy and constitute a cornerstone in supportive measures for cancer patients in general. Randomized controlled trials have shown non-inferiority or even superiority of restrictive transfusion guidelines over liberal transfusion guidelines in specific clinical situations outside of medical oncology. In this study, we analysed whether more restrictive RBC transfusion reduces blood use without affecting hard outcomes. MATERIALS AND METHODS A total of 352 AML patients diagnosed between 2007 and 2018 and undergoing intensive induction chemotherapy were included in this retrospective analysis. In the less restrictive transfusion group, patients received RBC transfusion for haemoglobin levels below 8 g/dl (2007-2014). In the restrictive transfusion group, patients received RBC transfusion for haemoglobin levels below 7 g/dl (2016-2018). Liberal transfusion triggers were never endorsed. RESULTS A total of 268 (76·1%) and 84 (23·9%) AML patients fell into the less restrictive and restrictive transfusion groups, respectively. The less restrictive transfusion group had 1 g/dl higher mean haemoglobin levels, received their first RBC transfusions earlier and needed 1·5 more units of RBC during the hospital stay of induction chemotherapy. Febrile episodes, C-reactive protein levels, admission to the intensive care unit, length of hospital stay as well as response and survival rates did not differ between the two cohorts. CONCLUSION From our retrospective analysis, we conclude that a more restrictive transfusion trigger does not affect important outcomes of AML patients. The opportunity to test possible effects of the more severe anaemia in the restrictive transfusion group on quality of life was missed.
Collapse
Affiliation(s)
- Olivier Ballo
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Philine Fleckenstein
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Fagr Eladly
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Eva-Maria Kreisel
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Jan Stratmann
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg-Hessen, Goethe University, Frankfurt/Main, Germany
| | - Markus Müller
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg-Hessen, Goethe University, Frankfurt/Main, Germany
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gesine Bug
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Halvard Bonig
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg-Hessen, Goethe University, Frankfurt/Main, Germany
| | - Christian H Brandts
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Fabian Finkelmeier
- Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital, Goethe University, Frankfurt/Main, Germany
| |
Collapse
|
4
|
Li C, Qiu Q, Liu M, Liu X, Hu L, Luo X, Lai C, Zhao D, Zhang H, Gao X, Deng Y, Song Y. Sialic acid-conjugate modified liposomes targeting neutrophils for improved tumour therapy. Biomater Sci 2020; 8:2189-2201. [PMID: 32096498 DOI: 10.1039/c9bm01732a] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neutrophils are the most abundant white blood cells in humans. Many tumor-treatment methods that are related to tissue infiltration and the activation of neutrophils have been developed. In particular, one strategy, which aims to improve tumor treatment, involves the exploitation or targeting of activated neutrophils. Peripheral blood neutrophils (PBNs) from tumor-bearing mice display high expression of l-selectin, which is well known to be targeted by the sialic acid (SA) ligand. Hence, in this research, we developed a drug delivery platform involving liposomes modified with an SA conjugate that targets activated PBNs. The uptake of doxorubicin (DOX)-loaded liposomes by PBNs did not alter their activation and transmigration. Furthermore, in tumor-bearing mice, SA-modified liposomes displayed a greater tumor-targeting ability and stronger tumor treatment efficacy, which were mediated by the neutrophil infiltration induced by inflammatory factors released from the tumor microenvironment. In conclusion, SA-modified liposomal DOX was shown to be an effective neutrophil-mediated drug delivery system for tumor therapy.
Collapse
Affiliation(s)
- Cong Li
- College of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning 110016, China.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Network Pharmacology-Based Investigation of the System-Level Molecular Mechanisms of the Hematopoietic Activity of Samul-Tang, a Traditional Korean Herbal Formula. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:9048089. [PMID: 32104198 PMCID: PMC7040423 DOI: 10.1155/2020/9048089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022]
Abstract
Hematopoiesis is a dynamic process of the continuous production of diverse blood cell types to meet the body's physiological demands and involves complex regulation of multiple cellular mechanisms in hematopoietic stem cells, including proliferation, self-renewal, differentiation, and apoptosis. Disruption of the hematopoietic system is known to cause various hematological disorders such as myelosuppression. There is growing evidence on the beneficial effects of herbal medicines on hematopoiesis; however, their mechanism of action remains unclear. In this study, we conducted a network pharmacological-based investigation of the system-level mechanisms underlying the hematopoietic activity of Samul-tang, which is an herbal formula consisting of four herbal medicines, including Angelicae Gigantis Radix, Rehmanniae Radix Preparata, Paeoniae Radix Alba, and Cnidii Rhizoma. In silico analysis of the absorption-distribution-metabolism-excretion model identified 16 active phytochemical compounds contained in Samul-tang that may target 158 genes/proteins associated with myelosuppression to exert pharmacological effects. Functional enrichment analysis suggested that the targets of Samul-tang were significantly enriched in multiple pathways closely related to the hematopoiesis and myelosuppression development, including the PI3K-Akt, MAPK, IL-17, TNF, FoxO, HIF-1, NF-kappa B, and p53 signaling pathways. Our study provides novel evidence regarding the system-level mechanisms underlying the hematopoiesis-promoting effect of herbal medicines for hematological disorder treatment.
Collapse
|
6
|
A Modern View on the Diagnostic and Therapy Anemia Chronic Diseases Problems. Fam Med 2019. [DOI: 10.30841/2307-5112.3.2019.178588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
7
|
Kim YJ, Han KD, Cho KH, Kim YH, Park YG. Anemia and health-related quality of life in South Korea: data from the Korean national health and nutrition examination survey 2008-2016. BMC Public Health 2019; 19:735. [PMID: 31196013 PMCID: PMC6567528 DOI: 10.1186/s12889-019-6930-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/01/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Anemia is associated with impaired quality of life (QoL). We examined the relationship between anemia and QoL in the Korean population using the EuroQol five-dimensional (EQ-5D) questionnaire. METHODS Data of 30,526 subjects were included from the Korean National Health and Nutrition Examination Survey (2008-2016). The QoL was assessed using three-levels of the EQ-5D questionnaire (G1, G2, and G3). Analysis of variance was used to compare the prevalence of anemia according to the three levels of health status in each of the five dimensions of EQ-5D. Multiple linear regression analysis was used to evaluate the association between hemoglobin level and QoL, and multivariable logistic regression analysis was used to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) for low levels of each of the five dimensions of EQ-5D. RESULTS As the level of EQ-5D was worse (from G1 to G3), the prevalence of anemia increased (p for trend < 0.001). Hemoglobin level and EQ-5D showed positive association after adjusting for all covariates such as age, sex, smoking, alcohol drinking, exercise, education, income, marital status, urban living, diabetes mellitus, hypertension, hypercholesterolemia, chronic kidney disease, total calorie intake, and protein intake. Subjects with anemia had increased ORs for low levels (G2 + G3) of each dimension of EQ-5D compared to subjects without anemia. ORs and 95% CIs for mobility, self-care, and usual activities were 1.208(1.078, 1.353), 1.161(0.98, 1.376), and 1.331(1.173, 1.51), respectively, after adjusting for all covariates. Pain/discomfort and anxiety/depression were not associated with increased ORs for low levels of EQ-5D. CONCLUSIONS In South Korea, low QoL was associated with anemia, particularly in the mobility, self-care, and usual activities dimensions of EQ-5D.
Collapse
Affiliation(s)
- Young-Ju Kim
- Department of Medical Lifescience, The Catholic University College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Kyung Do Han
- Department of Medical Lifescience, The Catholic University College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Kyung-Hwan Cho
- Department of Medical Lifescience, The Catholic University College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, 73 Inchon-ro, Seoungbuk-Gu, Seoul, 136-705, South Korea
| | - Yong-Gyu Park
- Department of Medical Statistics, The Catholic University College of Medicine, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea.
| |
Collapse
|
8
|
Liao M, Xie Y, Yan J, Lin T, Ji S, Li Z, Zhao W, Yang Y, Lin L, Lin J. Effect of acupuncture at 3 anti-fatigue acupoints in the treatment of cancer-related fatigue in patients with cancer: Protocol for a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e15919. [PMID: 31169708 PMCID: PMC6571244 DOI: 10.1097/md.0000000000015919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF), is a common distressing symptom of cancer. What's more, "Three anti-fatigue acupoints" is one of the most important components of "Jin's 3-needle therapy" created by Rui Jin, a professor of Guangzhou University of Chinese Medicine, which can be used in the treatment of CRF. In this article, researchers will assess the safety and effect of acupuncture at 3 anti-fatigue acupoints on CRF in patients with cancer. METHODS Literature search for relevant articles up to October 2018 will be carried out in 9 databases: Cochrane Library, Embase, PubMed, VIP, CBM, CNKI, Wanfang Database, CiNii, and OASIS. The included literatures will be randomized controlled trials of acupuncture at 3 anti-fatigue acupoints on CRF in patients with cancer. The certain common scales, which reflect the patients' fatigue degree or life quality will be the primary outcome measures. The secondary outcome measures will be defined with the blood index. After collecting the data, we will utilize Stata V.13.0. to perform data synthesis, subgroup analysis, partial sequence analysis, sensitivity analysis, and so on. A funnel plot will be used to assess reporting biases. And the funnel plot will be evaluated by the Egger and Begg tests. The quality of evidence will be judged by the grading of recommendations assessment, development, and evaluation. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION Our study will provide the evidence for the clinical efficacy and safety of acupuncture at 3 anti-fatigue acupoints in the treatment of CRF.
Collapse
Affiliation(s)
- Muxi Liao
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Yizi Xie
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Jiao Yan
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Tong Lin
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Shuliang Ji
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Zongyao Li
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | | | - Yaqin Yang
- First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou
| | - Lizhu Lin
- Oncology Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jietao Lin
- Oncology Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
9
|
Razzaghdoust A, Mofid B, Peyghambarlou P. Predictors of chemotherapy-induced severe anemia in cancer patients receiving chemotherapy. Support Care Cancer 2019; 28:155-161. [DOI: 10.1007/s00520-019-04780-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/25/2019] [Indexed: 12/23/2022]
|
10
|
Ng O, Keeler B, Simpson JA, Madhusudan S, Brookes M, Acheson A. Feasibility of Intravenous Iron Isomaltoside to Improve Anemia and Quality of Life During Palliative Chemotherapy for Esophagogastric Adenocarcinoma. Nutr Cancer 2018; 70:1106-1117. [DOI: 10.1080/01635581.2018.1504090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Oliver Ng
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Barrie Keeler
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - John Alastair Simpson
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Srinivasan Madhusudan
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | | | - Austin Acheson
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| |
Collapse
|
11
|
Strauss WE, Auerbach M. Health-related quality of life in patients with iron deficiency anemia: impact of treatment with intravenous iron. PATIENT-RELATED OUTCOME MEASURES 2018; 9:285-298. [PMID: 30214332 PMCID: PMC6118263 DOI: 10.2147/prom.s169653] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Most physicians appear to be aware of the health consequences of advanced anemia, especially in the acute setting, frequently responding with a not inconsequential therapeutic default of transfusion. In contrast, the profound impact that chronic anemia, of any degree, may have on a patient’s performance is underappreciated. The focus of this review is to 1) delineate the consistent and broad impact of anemia on patient quality of life as documented by multiple well-validated patient-reported outcome instruments and 2) demonstrate the essential normalization of the debilitation as assessed by these instruments following the administration of intravenous iron.
Collapse
|
12
|
Sim YE, Sim SED, Seng C, Howe TS, Koh SB, Abdullah HR. Preoperative Anemia, Functional Outcomes, and Quality of Life After Hip Fracture Surgery. J Am Geriatr Soc 2018; 66:1524-1531. [DOI: 10.1111/jgs.15428] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/05/2018] [Accepted: 03/29/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Yilin Eileen Sim
- Department of Anesthesiology; Singapore General Hospital; Singapore
| | - Shao-en David Sim
- Department of Orthopedic Surgery; Singapore General Hospital; Singapore
| | - Chusheng Seng
- Department of Orthopedic Surgery; Singapore General Hospital; Singapore
| | - Tet Sen Howe
- Department of Orthopedic Surgery; Singapore General Hospital; Singapore
| | - Suang Bee Koh
- Department of Orthopedic Surgery; Singapore General Hospital; Singapore
| | | |
Collapse
|
13
|
Arslan M, Evrensel T, Kurt E, Demiray M, Gonullu G, Kanat O, Manavoglu O. Comparison of Clinical Outcomes of Different Erythropoietin Usage Strategies. TUMORI JOURNAL 2018; 90:394-8. [PMID: 15510982 DOI: 10.1177/030089160409000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim There is no comprehensive study that compares the different usage strategies of recombinant human erythropoietin (rHuEPO) in platinum-induced anemia. In order to clarify this issue, we conducted a prospective clinical study. Material and methods Seventy-seven patients were studied in three main groups. Group 1 (n = 17) consisted of cancer patients without anemia. These patients received rHuEPO starting from the first chemotherapy cycle. Group 2 (n = 26) consisted of patients whose hemoglobin (Hb) values decreased by at least 1 g/dL after the first cycle of chemotherapy. Group 3 (n = 34) consisted of patients whose Hb values dropped below 10.5 g/dL after the second chemotherapy cycle. Groups 2 and 3 were each divided into two subgroups. In groups 1, 2A and 3A rHuEPO (5000 U/day subcutaneously three times a week) treatment was continued until three weeks after the completion of chemotherapy. In groups 2B and 3B, rHuEPO was given for 12 weeks only. Results There were no prominent differences between the Hb values of these groups throughout the chemotherapy cycles. Transfusion rates and the number of patients who became anemic were also not different between groups. Conclusion No rHuEPO usage strategies are superior to others in terms of Hb levels and transfusion requirements. The decision as to when rHuEPO is to be added to platinum-containing therapy should be tailored to the health conditions of individual patients.
Collapse
Affiliation(s)
- Murat Arslan
- Uludag University Faculty of Medicine, Department of Medical Oncology, Bursa, Turkey.
| | | | | | | | | | | | | |
Collapse
|
14
|
Bajetta E, Vercammen E, Reinhardt U, Janmohamed R, da Costa RM, Matulonis U, Guastalla JP. Efficacy of Epoetin Alfa in a Retrospective Non-stratified Subgroup Analysis of a Breast Cancer Cohort Receiving Non-platinum Chemotherapy. TUMORI JOURNAL 2018; 90:449-57. [PMID: 15656327 DOI: 10.1177/030089160409000501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background More than 60% of patients with metastatic breast cancer receiving non-platinum-based chemotherapy experience anemia, which is associated with fatigue and impaired quality of life. Epoetin alfa treatment in patients with a variety of malignancies has been shown to decrease transfusion requirements and improve hemoglobin levels and quality-of-life efficacy parameters. Patients Retrospective subgroup analyses were performed in patients with breast cancer who were part of a multinational, randomized (2:1), double-blind, placebo-controlled trial of anemic cancer patients (n = 375) undergoing non-platinum-based chemotherapy. Results In the breast cancer subpopulation (n = 114, 48% with stage IV disease at baseline), the hemoglobin increase was greater for epoetin alfa patients than placebo patients (2.3 versus 0.9 g/dL). Epoetin alfa patients had lower transfusion requirements (28.2% versus 33.3%), improvement or preservation versus deterioration of quality of life, and a higher proportion of responders (patients achieving a ≥2 g/dL increase in hemoglobin levels unrelated to transfusion) (68.0% versus 22.9% for placebo). The results were similar to those observed in the full study cohort, where statistical analyses showed the differences to be significant (P <0.05 for all). Epoetin alfa treatment was well tolerated. Although the study was not designed or powered for survival as an endpoint, Kaplan-Meier estimates for the full cohort showed a trend in overall survival favoring epoetin alfa treatment (P= 0.13, log rank test); a similar benefit was seen in the breast cancer subpopulation. Conclusions In the full study cohort and the breast cancer subpopulation, epoetin alfa effectively treated anemia (increased hemoglobin levels and decreased transfusion requirements) and improved or preserved quality of life. Results concerning potential survival benefits support further study of epoetin alfa in anemic cancer patients.
Collapse
Affiliation(s)
- Emilio Bajetta
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
15
|
Smaniotto D, Luzi S, Morganti AG, Cellini N. Prognostic Significance of Anemia and Role of Erythropoietin in Radiation Therapy. TUMORI JOURNAL 2018; 86:17-23. [PMID: 10778761 DOI: 10.1177/030089160008600104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anemia represents a common finding in cancer patients, especially at an advanced stage. Anemia has an impact on the quality of life and at the same time seems to markedly limit the disease control that can be achieved with radiotherapy. The results of a series of clinical studies published in the last decade allow some general observations: 1. the administration of erythropoietin, especially if associated to ferrous sulfate is able to increase hemoglobulin levels in cancer patients undergoing radiation therapy (combined with concomitant chemotherapy); 2. erythropoietin stimulation of hemoglobin in anemia decreases the need for blood transfusion in cancer patients; 3. tumor response to radiation therapy appears to be enhanced by erythropoietin-induced hemoglobulin increase. Further clinical studies are required for assessment of indications, identification of optimal administration modalities, cost-analysis of this promising therapy for patients undergoing radiation therapy.
Collapse
Affiliation(s)
- D Smaniotto
- Cattedra di Radioterapia, Università Cattolica del Sacro Cuore, Roma, Italia.
| | | | | | | |
Collapse
|
16
|
Gascón P, Arranz R, Bargay J, Ramos F. Fatigue- and health-related quality-of-life in anemic patients with lymphoma or multiple myeloma. Support Care Cancer 2017; 26:1253-1264. [PMID: 29116407 DOI: 10.1007/s00520-017-3948-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe perceptions of fatigue in anemic patients with lymphoma or multiple myeloma (MM). METHODS This is an observational multicenter study in a prospective cohort of lymphoma and MM patients with hemoglobin ≤ 11 g/dl managed under clinical practice. Fatigue was assessed at baseline and after 3 months using the PERFORM questionnaire, the Functional Assessment of Cancer Therapy-Fatigue, the linear analogue self-assessment, and visual analogue scale (VAS) scales. RESULTS Two hundred and fifty patients (125 with lymphoma, 125 with MM) were included. Only 59.2 and 56.0% of patients received treatment for anemia, respectively. After 3 months, the hemoglobin levels increased significantly compared to baseline from 10.0 ± 1.2 to 11.5 ± 1.8 in the lymphoma group and from 9.9 ± 0.9 to 10.9 ± 1.5 g/dl, in the MM group (P < 0.001, both comparisons). At baseline, 87.2 and 84.8% of patients had fatigue (median intensity (VAS) 60 and 50). The overall PERFORM score decreased from 35.2 ± 15.2 to 32.0 ± 14.6 (P = 0.048), without differences between groups. No statistically significant changes were observed in the other scales. After multivariable adjustment, the only common independent factor associated to improvements in fatigue and health-related quality-of-life (HRQoL) was an increase in hemoglobin levels. The administration of curative intention treatment was also associated with HRQoL improvements. The psychometric properties of the PERFORM questionnaire in MM patients were good (Cronbach's alpha 0.87-0.98; intraclass correlation coefficients 0.84-0.89; effect sizes 0.59-0.96). CONCLUSIONS Almost all patients with lymphoma or MM diagnosed with anemia suffered from fatigue of moderate to severe intensity. Despite similar anemia supportive treatment, better correction of fatigue scores was observed in lymphoma patients after 3 months. Increases in hemoglobin were significantly associated to improvements in fatigue and HRQoL.
Collapse
Affiliation(s)
- Pere Gascón
- Hospital Clínic, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - Reyes Arranz
- Hospital Universitario de La Princesa, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Joan Bargay
- Hospital Son Llatzer, Carretera de Manacor, Km. 4, 07198, Palma de Mallorca, Spain
| | - Fernando Ramos
- Hospital Universitario de León, Calle Altos de Nava, s/n, 24008, Leon, Spain
| |
Collapse
|
17
|
Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis. Med Oncol 2017; 34:174. [DOI: 10.1007/s12032-017-1021-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/17/2017] [Indexed: 12/12/2022]
|
18
|
Abstract
BACKGROUND Anemia is an issue of concern in the management of older patients with cancer. In this age group, the incidence and prevalence of both cancer and anemia increase with age. METHODS The clinical consequences and the management of anemia, a common comorbid condition in older patients with cancer, are explored. RESULTS Common causes of chronic anemia include iron deficiency and anemia of chronic disease. The prevalence of vitamin B12 deficiency due to reduced absorption of food-bound vitamin B12 also increases with aging. Although in many cases the cause of anemia is not found, a primary deficiency of erythropoietin may be at fault in at least some of these cases since the response of erythropoietin to anemia may decrease in individuals over age 70. CONCLUSIONS Anemia should not necessarily be ascribed to cancer or aging. The causes of anemia should be pursued and reversed, and hemoglobin levels should be maintained at a minimum of 12 g/dL in cancer patients undergoing chemotherapy who are responsive to erythropoietin. The reversal of anemia may offset or delay the accumulation of catabolic cytokines that may be responsible for functional decline in aging individuals.
Collapse
Affiliation(s)
- Lodovico Balducci
- Senior Adult Oncology Program, H. Lee Moffitt Cancer Center Research Institute, Tampa, FL 33612, USA.
| |
Collapse
|
19
|
Fabi A, Falcicchio C, Giannarelli D, Maggi G, Cognetti F, Pugliese P. The course of cancer related fatigue up to ten years in early breast cancer patients: What impact in clinical practice? Breast 2017; 34:44-52. [PMID: 28500901 DOI: 10.1016/j.breast.2017.04.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022] Open
Abstract
Little is known about the cancer related fatigue (CRF) along cancer course and risk factors that could predict CRF development and persistence in breast cancer (BC) survivors. This prospective study detected incidence, timing of onset, duration of CRF, impact on QoL and psychological distress. Seventy-eight early BC patients, undergoing chemotherapy (CT) followed or not by hormonal therapy were assessed for QoL and psychological distress by EORTC QLQC30 and HADs questionnaires. Fatigue was investigated with mix methods, structured interview and psychometric measures. A qualitative analysis was added to assess the behavioral pattern of CRF. Low fatigue levels were identified after surgery (9%), increasing during (49%) and at the end of CT (47%), maintaining after 1 year (31%) and declining up to ten years of follow-up. Prevalence of CRF was higher at the end of CT and lower at follow-up. At the end and after 1 and 2 years from CT, persistence of CRF was associated to anxiety in 20%, 11% and 5% and to depression in 15%, 10% and 5% respectively. A relationship between CRF and psychological distress was observed; patients presenting depression and anxiety before CT were at higher risk for fatigue onset at a later period. A relationship between fatigue and QoL was noted at the end of CT. Our study shows the fatigue timely trend in early BC patients from surgery, CT and follow-up. Identification of biological, psychological, social predictor factors related to fatigue could be helpful for early interventions in patients at higher risk of developing fatigue.
Collapse
Affiliation(s)
- Alessandra Fabi
- Regina Elena National Cancer Institute, Division of Medical Oncology 1, via Elio Chianesi 53, 00124, Rome, Italy.
| | - Chiara Falcicchio
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
| | - Diana Giannarelli
- Regina Elena National Cancer Institute, Biostatistic Unit, via Elio Chianesi 53, 00124, Rome, Italy
| | - Gabriella Maggi
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
| | - Francesco Cognetti
- Regina Elena National Cancer Institute, Division of Medical Oncology 1, via Elio Chianesi 53, 00124, Rome, Italy
| | - Patrizia Pugliese
- Regina Elena National Cancer Institute, Service of Psiconcology, via Elio Chianesi 53, 00124, Rome, Italy
| |
Collapse
|
20
|
Chen L, Jiang H, Gao W, Tu Y, Zhou Y, Li X, Zhu Z, Jiang Q, Zhan H, Yu J, Fu C, Gao Y. Combination with intravenous iron supplementation or doubling erythropoietin dose for patients with chemotherapy-induced anaemia inadequately responsive to initial erythropoietin treatment alone: study protocol for a randomised controlled trial. BMJ Open 2016; 6:e012231. [PMID: 27855097 PMCID: PMC5073518 DOI: 10.1136/bmjopen-2016-012231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Erythropoietin (EPO) is a commonly used option in the treatment of chemotherapy-induced anaemia (CIA). However, ∼30-50% of patients fail to achieve an adequate response after initial treatment. Prior studies have demonstrated that intravenous iron might synergistically improve therapeutic response to EPO treatment in this patient population. METHODS AND ANALYSIS We will perform this multicentre, randomised, open-label, parallel-group, active controlled non-inferiority study to compare the two combination therapies of EPO plus intravenous iron regimen versus doubling the dose of EPO in patients with CIA who have an inadequate response to initial EPO treatment at a routine dose. A total of 603 patients with an increase in haemoglobin (Hb) <1 g/dL will be enrolled and randomised to one of the three study treatment groups at a 1:1:1 ratio Group 1: EPO treatment at the original dose plus intravenous iron dextran 200 mg every 3 weeks (Q3W) for 15 weeks; Group 2: EPO treatment at the original dose plus intravenous iron dextran 100 mg, twice a week for 5 weeks; Group 3: the control group, doubling the EPO dose without preplanned iron supplementation. The primary outcome measure to compare is the Hb response rate at week 15 and the secondary end points involve therapeutic blood transfusions. Time-to-progression, adverse events and quality of life will also be evaluated. ETHICS AND DISSEMINATION All participants will provide informed consent; the study protocol has been approved by the independent ethics committee of Shanghai East Hospital. This study would clearly demonstrate the potential benefit of combining epoetin treatment with intravenous iron supplementation. Findings will be shared with participating hospitals, policymakers and the academic community to promote the clinical management of CIA in China. TRIAL REGISTRATION NUMBER NCT02731378.
Collapse
Affiliation(s)
- Lin Chen
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong Jiang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Gao
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ye Tu
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Zhou
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi Li
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhe Zhu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qixin Jiang
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haifeng Zhan
- Department of Gynecology, Jing'an District Centre Hospital of Shanghai (Huashan Hospital Fudan University Jing'an Branch), Shanghai, China
| | - Jiangming Yu
- Department of Orthopaedics, Changzheng Hospital, Shanghai, China
| | - Chuangang Fu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong Gao
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
21
|
Williams LA, Bohac C, Hunter S, Cella D. Patient and health care provider perceptions of cancer-related fatigue and pain. Support Care Cancer 2016; 24:4357-63. [PMID: 27207616 PMCID: PMC4993798 DOI: 10.1007/s00520-016-3275-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE In 1997, Vogelzang et al. reported that 61 % of patients with cancer indicated fatigue impacted daily life more than pain, and only 37 % of oncologists shared this perception. We provide an update to this study, which can help prioritize symptom assessment and management in the clinic. Study aims were to determine and compare perceptions of patients with cancer and health care providers (HCPs) of the impact of fatigue and pain. METHODS A random sample of patients with cancer was recruited in the USA by Harris Poll Online and Schlesinger Associates. Oncology HCPs were recruited by Food and Drug Research, Inc. and Toluna, Inc. RESULTS From June to November 2012, 550 of 1122 eligible patients (49 %), 400 of 533 eligible oncologists (75 %), and 400 of 617 eligible oncology nurses (65 %) completed a survey. Of patients, 58 % reported that fatigue affected their daily lives more than pain while undergoing treatment with chemotherapy versus 29 % of oncologists and 25 % of oncology nurses that had this perception. Ninety-eight percent of patients reported experiencing fatigue, whereas 72 % of oncologists and 84 % of oncology nurses thought this was the case. Eighty-six percent of patients reported pain while undergoing treatment with chemotherapy, whereas 36 % of oncologists and 51 % of oncology nurses believed this occurred. Nausea and vomiting felt by HCPs were the most concerning symptoms for patients (88 %). CONCLUSIONS This study shows the importance of assessing symptoms by direct patient report during chemotherapy treatment. HCPs continue to underestimate the prevalence and importance of fatigue and pain for patients with cancer, a finding that may alter the management of treatment-related symptoms and may influence the development of patient symptom management plans.
Collapse
Affiliation(s)
- Loretta A Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Drive, Houston, TX, 77030, USA.
| | - Chet Bohac
- Amgen, Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Sharon Hunter
- Amgen, Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, Suite 1900, Chicago, IL, 60611, USA
| |
Collapse
|
22
|
Kanuri G, Sawhney R, Varghese J, Britto M, Shet A. Iron Deficiency Anemia Coexists with Cancer Related Anemia and Adversely Impacts Quality of Life. PLoS One 2016; 11:e0163817. [PMID: 27682226 PMCID: PMC5040456 DOI: 10.1371/journal.pone.0163817] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/14/2016] [Indexed: 12/22/2022] Open
Abstract
Cancer related anemia (CRA) adversely affects patient Quality of Life (QoL) and overall survival. We prospectively studied the prevalence, etiology and the impact of anemia on QoL in 218 Indian cancer patients attending a tertiary referral hospital. The study used the sTfR/log Ferritin index to detect iron deficiency anemia and assessed patient QoL using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) tool, standardized for language. Mean patient age was 51±13 years and 60% were female. The prevalence of cancer related anemia in this setting was 64% (n = 139). As expected, plasma ferritin did not differ significantly between anemic (n = 121) and non-anemic cancer patients (n = 73). In contrast, plasma sTfR levels were significantly higher in anemic cancer patients compared to non-anemic cancer patients (31 nmol/L vs. 24 nmol/L, p = 0.002). Among anemic cancer patients, using the sTfR/log Ferritin index, we found that 60% (n = 83) had iron deficiency anemia (IDA). Interestingly, plasma sTfR levels were significantly higher in cancer patients with CRA+IDA (n = 83) compared with patients having CRA (n = 38) alone (39 nmol/L vs. 20 nmol/L, p<0.001). There was a significant linear correlation between Hb and QoL (Spearman ρ = 0.21; p = 0.001) and multivariate regression analysis revealed that every gram rise in Hb was accompanied by a 3.1 unit increase in the QoL score (95% CI = 0.19–5.33; p = 0.003). The high prevalence of anemia in cancer patients, a major portion of which is due to iron deficiency anemia, the availability of sensitive and specific biomarkers of iron status to detect IDA superimposed on anemia of inflammation, suggests an urgent need to diagnose and treat such patients. Despite the potential negative consequences of increasing metabolically available plasma iron in cancer, our clinical data suggest that detecting and treating IDA in anemic cancer patients will have important consequences to their QoL and overall survival. Clinical trials of iron therapy in these patients will be able to demonstrate the potential for benefit or harm.
Collapse
Affiliation(s)
- Giridhar Kanuri
- Wellcome Trust- DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Ritica Sawhney
- Wellcome Trust- DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Jeeva Varghese
- College of Nursing, St. John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Madonna Britto
- College of Nursing, St. John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Arun Shet
- Wellcome Trust- DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
- Department of Medical Oncology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
- * E-mail:
| |
Collapse
|
23
|
M Kolesar J, Duren BA, Baranski BG. Retrospective evaluation of response to epoetin alfa in patients with hematologic disorders. J Oncol Pharm Pract 2016. [DOI: 10.1191/1078155204jp117oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Study objectives. To evaluate the impact of epoetin therapy in patients with hematologic malignancies and myelodysplasias (MDS) on hemoglobin (Hb) response, transfusion requirements and to evaluate factors, such as endogenous erythropoietin levels and serum creatinine that predict response to epoetin therapy. Methods. Inpatient and outpatient pharmacy records were analysed to identify patients with hematological disorders receiving epoetin therapy. No patients were receiving treatment with chemotherapy. Baseline and final Hb levels and transfusion requirements were analysed and factors predicting response to epoetin were evaluated. Results. The mean baseline Hb increased from 9.9 g/dL (91.09) to 12.1 g/dL (91.84) for a mean Hb increase of 2.81 g/dL (P 5 3.3 3 102 12) and 29 of 35 patients experienced clinical benefit to the epoetin. Overall, the mean transfusion burden fell from 0.94 units of packed red blood cells per month to 0.38 units/month (P 5 0.034 by paired t-test) at the end of the evaluation period. When measured by percentage of patients requiring transfusions, 42% had a transfusion the month prior to receiving epoetin, where as only 11% required transfusions while receiving epoetin. The mean endogenous erythropoietin was 51.2 IU/L (n 5 25) in the patients who responded to epoetin and 129 IU/L (n 5 2) in the nonresponder group (P 5 0.012), although two individuals with endogenous erythropoetin levels greater than 200 IU/L responded to epoetin. Thirteen of 14 patients with MDS in this series responded to epoetin, and the only patient not responding was progressing to AML. Conclusions. Epoetin is effective in improving anemia in patient’s with hematological malignancies not receiving chemotherapy. While the numbers in this retrospective evaluation are small, it appears that patients with low endogenous erythropoetin levels and high serum creatinine are most likely to respond; a relationship that could be explored in future larger and prospective evaluations.
Collapse
Affiliation(s)
- Jill M Kolesar
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Avenue, Madison, WI 53705-2222, USA
| | - Betsy A Duren
- Nursing Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Bruce G Baranski
- Chief - Hematology, William S. Middleton Veterans Administration Hospital, Madison, WI, USA, and Associate Professor of Medicine, University of Wisconsin
| |
Collapse
|
24
|
Caggiano V, Gupta S, Tannous RE, Fridman M, Carter WB. Chemotherapy-induced moderate tolife-threatening anemia in early-stage breast cancer. J Oncol Pharm Pract 2016. [DOI: 10.1191/1078155201jp083oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose. We evaluated the incidence and severity of anemia experienced by women treated with doxorubicin and cyclophosphamide (AC) therapy for early-stage breast cancer are described. We also explored the possibility of identifying clinical characteristics that will allow early identification of women more likely to develop anemia and may require anemia treatment. Methods. This study used a historic case series from 13 oncology practices that participated in the Oncology Practice Pattern Study. The analysis focused on 411 patients who received AC chemotherapy from 1993 through 1999. Seventeen percent of the study population was excluded from the analysis due to missing data. Anemia was defined as a hemoglobin (Hb) value of < 12 g/dL. Hb ≤10 g/dL was considered the threshold value for treatment. Results. Among patients receiving AC, 18.0% was anemic prior to chemotherapy. Overall, 14.9 -16.9% of women with early-stage breast cancer who started AC chemotherapy with a normal Hb (≥12 g/dL) developed anemia. Nearly 11% developed severe to life-threatening anemia (Hb < 8 g/dL). Data on blood transfusions and erythropoietic therapy were unavailable. Multivariate logistic regression analysis showed that patients who started with a normal prechemotherapy Hb and dropped to ≤10 g/dL at some point during chemotherapy were more likely to be ≥65 years of age, have a low body surface area (< 1.78), and have four or more positive nodes. Conclusion. The incidence of anemia increased substantially from baseline to post-chemotherapy. The data suggested the importance of monitoring and managing Hb levels of patients at increased risk for developing chemotherapy-induced anemia.
Collapse
Affiliation(s)
| | - Sanjay Gupta
- Medical Affairs, Pharmacoeconomics, Amgen, Inc., Thousand Oaks, California
| | - Rima E Tannous
- Medical Affairs, Pharmacoeconomics, Amgen, Inc., Thousand Oaks, California
| | | | - William B Carter
- Medical Affairs, Pharmacoeconomics, Amgen, Inc., Thousand Oaks, California
| |
Collapse
|
25
|
Caggiano V, Tannous RE, Gupta S, Fridman M. Chemotherapy-induced moderate to severe anemia in intermediate-grade non-Hodgkin’s lymphoma patients. J Oncol Pharm Pract 2016. [DOI: 10.1191/1078155202jp091oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study investigated the incidence of anemia in chemotherapy-treated intermediate-grade non-Hodgkin’s lymphoma (IGNHL) patients. A historic case series design was used. The study data were obtained from 12 oncology practices that participated in the Oncology Practice Pattern Study (OPPS). The analysis focused on 353 IGNHL patients with normal baseline (prechemotherapy) hemoglobin (Hb) (≥12.0 g/dL). These patients were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone combination) therapy (at some point) from 1993 through 1999. Anemia was found to be prominent during chemotherapy. About 24% of the patients with a normal baseline Hb level dropped below 10.0 g/dL and 49% dropped to 10.0 -11.9 g/dL, at some point during chemotherapy. As anemia treatment data were unavailable, it is likely that some of these patients received therapy to boost their Hb levels, rendering our results conservative. A logistic regression model revealed that in patients with normal baseline Hb, age ≥60, female gender, lower baseline Hb level, and lymphoma histology classified as the Working Formulation (WF) E or H were significant predictors of a drop in Hb below 10.0 g/dL during chemotherapy. Chemo-therapy-induced anemia is frequently observed in lymphoma patients. It is possible to identify adverse baseline patient characteristics associated with higher risk of chemotherapy-induced anemia and carefully monitor such patients. Additional studies in community oncology practice are warranted to validate these findings and improve our understanding of the problems of anemia in chemotherapy treated non-Hodgkin’s lymphoma (NHL) patients.
Collapse
Affiliation(s)
- Vincent Caggiano
- Sutter Cancer Center, and Sutter Institute for Medical Research, Sacramento, California
| | | | | | | |
Collapse
|
26
|
Goram AL. Factors and Predictors of Response with Epoetin Alfa for Chemotherapy-Related Anemia. J Pharm Technol 2016. [DOI: 10.1177/875512250001600602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To describe the value of specific factors and predictors that influence the use of epoetin alfa for anemia in adults with cancer receiving chemotherapy with or without radiation therapy. Data Sources: Data search restricted to English-language literature on epoetin alfa identified by MEDLINE searches (1990-July 2000) and other pertinent literature was conducted. Data Synthesis: Anemia of chronic disease (ACD) is a common finding among cancer patients. Patients receiving repeated or multiple chemotherapy regimens alone or with radiation therapy may worsen ACD. Blood transfusion is the cornerstone of treatment. Risks associated with allogeneic blood transfusion are clearly established. This includes alteration of the immune system, acute allergic reactions, viral and bacterial infections, tumor reappearance, and reduced quality of life (QOL). As the demand for blood increased and periodic supply shortages occurred, healthcare centers began seeking alternatives to blood transfusion. Recombinant human erythropoietin (epoetin alfa) is a prophylactic or treatment option that can reduce the need for blood transfusion with an improved QOL. Albeit clinically beneficial, epoetin alfa is expensive. Using predictors during early use with epoetin alfa, clinicians can identify patients most likely and least likely to benefit from further therapy, thus preventing costly outcomes. The change in hemoglobin (>0.5–1.0 g/dL) combined with either endogenous erythropoietin concentration (<100 mU/mL) or absolute reticulocyte count increase (>40,000 cells/uL) two to four weeks after starting therapy provided the most powerful prediction of response to epoetin alfa. Conclusions: Key factors and predictors with epoetin alfa can optimize therapy outcomes in cancer patients receiving chemotherapy.
Collapse
|
27
|
Fecková B, Kimáková P, Ilkovičová L, Szentpéteriová E, Debeljak N, Solárová Z, Sačková V, Šemeláková M, Bhide M, Solár P. Far-western blotting as a solution to the non-specificity of the anti-erythropoietin receptor antibody. Oncol Lett 2016; 12:1575-1580. [PMID: 27446474 DOI: 10.3892/ol.2016.4782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/24/2016] [Indexed: 12/13/2022] Open
Abstract
The erythropoietin receptor (EpoR) is a member of the cytokine receptor family. The interaction between erythropoietin (Epo) and EpoR is important for the production and maturation of erythroid cells, resulting in the stimulation of hematopoiesis. The fact that EpoR was also detected in neoplastic cells has opened the question about the relevance of anemia treatment with recombinant Epo in cancer patients. Numerous studies have reported pro-stimulating and anti-apoptotic effects of Epo in cancer cells, thus demonstrating EpoR functionality in these cells. By contrast, a previous study claims the absence of EpoR in tumor cells. This apparent discrepancy is based, according to certain authors, on the use of non-specific anti-EpoR antibodies. With the aim of bypassing the direct detection of EpoR with an anti-EpoR antibody, the present authors propose a far-western blot methodology, which in addition, confirms the interaction of Epo with EpoR. Applying this technique, the presence of EpoR and its interaction with Epo in human ovarian adenocarcinoma A2780 and normal human umbilical vein endothelial cells was confirmed. Furthermore, modified immunoprecipitation of EpoR followed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry analysis confirmed a 57 kDa protein as a human Epo-interacting protein in both cell lines.
Collapse
Affiliation(s)
- Barbora Fecková
- Department of Cell Biology, Institute of Biology and Ecology, Faculty of Science, Pavol Jozef Šafárik University in Košice, SK-04154 Košice, Slovak Republic
| | - Patrícia Kimáková
- Department of Cell Biology, Institute of Biology and Ecology, Faculty of Science, Pavol Jozef Šafárik University in Košice, SK-04154 Košice, Slovak Republic
| | - Lenka Ilkovičová
- Department of Cell Biology, Institute of Biology and Ecology, Faculty of Science, Pavol Jozef Šafárik University in Košice, SK-04154 Košice, Slovak Republic
| | - Erika Szentpéteriová
- Department of Cell Biology, Institute of Biology and Ecology, Faculty of Science, Pavol Jozef Šafárik University in Košice, SK-04154 Košice, Slovak Republic
| | - Nataša Debeljak
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Zuzana Solárová
- Institute of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, SK-04001 Košice, Slovak Republic
| | - Veronika Sačková
- Department of Cell Biology, Institute of Biology and Ecology, Faculty of Science, Pavol Jozef Šafárik University in Košice, SK-04154 Košice, Slovak Republic
| | - Martina Šemeláková
- Department of Cell Biology, Institute of Biology and Ecology, Faculty of Science, Pavol Jozef Šafárik University in Košice, SK-04154 Košice, Slovak Republic
| | - Mangesh Bhide
- Laboratory of Biomedical Microbiology and Immunology, University of Veterinary Medicine, SK-04181 Košice, Slovak Republic
| | - Peter Solár
- Department of Cell Biology, Institute of Biology and Ecology, Faculty of Science, Pavol Jozef Šafárik University in Košice, SK-04154 Košice, Slovak Republic
| |
Collapse
|
28
|
Leyland-Jones B, Bondarenko I, Nemsadze G, Smirnov V, Litvin I, Kokhreidze I, Abshilava L, Janjalia M, Li R, Lakshmaiah KC, Samkharadze B, Tarasova O, Mohapatra RK, Sparyk Y, Polenkov S, Vladimirov V, Xiu L, Zhu E, Kimelblatt B, Deprince K, Safonov I, Bowers P, Vercammen E. A Randomized, Open-Label, Multicenter, Phase III Study of Epoetin Alfa Versus Best Standard of Care in Anemic Patients With Metastatic Breast Cancer Receiving Standard Chemotherapy. J Clin Oncol 2016; 34:1197-207. [PMID: 26858335 DOI: 10.1200/jco.2015.63.5649] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE An open-label, noninferiority study to evaluate the impact of epoetin alfa (EPO) on tumor outcomes when used to treat anemia in patients receiving chemotherapy for metastatic breast cancer. METHODS Women with hemoglobin ≤ 11.0 g/dL, receiving first- or second-line chemotherapy for metastatic breast cancer, were randomly assigned to EPO 40,000 IU subcutaneously once a week or best standard of care. The primary end point was progression-free survival (PFS). Secondary end points included overall survival, time to tumor progression, overall response rate, RBC transfusions, and thrombotic vascular events. RESULTS In 2,098 patients randomly assigned, median PFS (based on investigator-determined disease progression [PD]) was 7.4 months in both groups (hazard ratio [HR], 1.089; 95% CI, 0.988 to 1.200); upper bound exceeded prespecified noninferiority margin of 1.15. Median PFS per independent review committee-determined PD was 7.6 months in both groups (HR, 1.028; 95% CI, 0.922 to 1.146); upper bound did not exceed prespecified noninferiority margin. Median overall survival at clinical cutoff (1,337 deaths) was 17.2 months in the EPO and 17.4 months in the best standard of care group (HR, 1.057; 95% CI, 0.949 to 1.177), median time to tumor progression was 7.5 months in both groups (HR, 1.094; 95% CI, 0.991 to 1.209), and overall response rate was 50% versus 51% (odds ratio, 0.950; 95% CI, 0.799 to 1.130). RBC transfusions were 5.8% versus 11.4% (P < .001), and thrombotic vascular events were 2.8% versus 1.4% (P = .038), respectively. CONCLUSION The primary end point, PFS based on investigator-determined PD, did not meet noninferiority criteria. As a consistency assessment with the primary finding, PFS based on independent review committee-determined PD met noninferiority criteria. Overall, this study did not achieve noninferiority objective in ruling out a 15% increased risk in PD/death. RBC transfusion should be the preferred approach for the management of anemia in this population.
Collapse
Affiliation(s)
- Brian Leyland-Jones
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ.
| | - Igor Bondarenko
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Gia Nemsadze
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Vitaliy Smirnov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Iryna Litvin
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Irakli Kokhreidze
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Lia Abshilava
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Mikheil Janjalia
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Rubi Li
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Kuntegowda C Lakshmaiah
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Beka Samkharadze
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Oksana Tarasova
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Ranjan Kumar Mohapatra
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Yaroslav Sparyk
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Sergey Polenkov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Vladimir Vladimirov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Liang Xiu
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Eugene Zhu
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Bruce Kimelblatt
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Kris Deprince
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Ilya Safonov
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Peter Bowers
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| | - Els Vercammen
- Brian Leyland-Jones, Avera Cancer Institute, Sioux Falls, SD; Igor Bondarenko, Dnepropetrovsk Medical Academy; and Iryna Litvin, Dnepropetrovsk Regional Oncological Dispensary, Dnepropetrovsk; Vitaliy Smirnov, Donetsk Regional Anticancer Center, Donetsk; Oksana Tarasova, Institute of Medical Radiology, Kharkiv; Yaroslav Sparyk, Lviv State Oncology Regional Treatment and Diagnostic Centre, Lviv; and Sergey Polenkov, Chernigov Regional Oncology Center, Chernigov, Ukraine; Gia Nemsadze, Institute of Clinical Oncology (LTD. K. Madichi Mammological Center); Irakli Kokhreidze, Martin D. Abeloff Laboratory Cancer Research Center; Lia Abshilava, Chemotherapy and Immunotherapy Clinic Medulla; Mikheil Janjalia, Tbilisi Cancer Center; and Beka Samkharadze, Research Institute of Clinical Medicine, Tbilisi, Georgia; Rubi Li, St. Luke's Medical Center, Quezon City, Philippines; Kuntegowda C. Lakshmaiah, Kidwai Memorial Institute of Oncology, Bangalore; and Ranjan Kumar Mohapatra, Apollo Specialty Hospital, Chennai, India; Vladimir Vladimirov, Pyatigorsk Oncology Dispensary, Pyatigorsk, Russian Federation; and Liang Xiu, Eugene Zhu, Bruce Kimelblatt, Kris Deprince, Ilya Safonov, Peter Bowers, and Els Vercammen, Janssen Research & Development, Raritan, NJ
| |
Collapse
|
29
|
Mhaskar R, Wao H, Miladinovic B, Kumar A, Djulbegovic B. The role of iron in the management of chemotherapy-induced anemia in cancer patients receiving erythropoiesis-stimulating agents. Cochrane Database Syst Rev 2016; 2:CD009624. [PMID: 26845108 PMCID: PMC8765740 DOI: 10.1002/14651858.cd009624.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) are commonly used to treat chemotherapy-induced anemia (CIA). However, about half of patients do not benefit. OBJECTIVES To evaluate the benefits and harms related to the use of iron as a supplement to ESA and iron alone compared with ESA alone in the management of CIA. SEARCH METHODS We searched for relevant trials from the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 1 January 2016), MEDLINE (1950 to February 2016), and www.clinicaltrials.gov without using any language limits. SELECTION CRITERIA All randomized controlled trials (RCTs) comparing 'iron plus ESA' or 'iron alone' versus 'ESA alone' in people with CIA were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included eight RCTs (12 comparisons) comparing ESA plus iron versus ESA alone enrolling 2087 participants. We did not find any trial comparing iron alone versus ESAs alone in people with CIA. None of the included RCTs reported overall survival. There was a beneficial effect of iron supplementation to ESAs compared with ESAs alone on hematopoietic response (risk ratio (RR) 1.17, 95% confidence interval (CI) 1.09 to 1.26; P < 0.0001; 1712 participants; 11 comparisons; high-quality evidence). Assuming a baseline risk of 35% to 80% for hematopoietic response without iron supplementation, between seven and 16 patients should be treated to achieve hematopoietic response in one patient. In subgroup analyses, RCTs that used intravenous (IV) iron favored ESAs and iron (RR 1.20 (95% CI 1.10 to 1.31); P < 0.00001; 1321 participants; eight comparisons), whereas we found no evidence for a difference in hematopoietic response in RCTs using oral iron (RR 1.04 (95% CI 0.87 to 1.24); P = 0.68; 391 participants; three comparisons). There was no evidence for a difference between the subgroups of IV and oral iron (P = 0.16). There was no evidence for a difference between the subgroups of types of iron (P = 0.31) and types of ESAs (P = 0.16) for hematopoietic response.The iron supplementation to ESAs might be beneficial as fewer participants treated with iron supplementation required red blood cell (RBC) transfusions compared to the number of participants treated with ESAs alone (RR 0.74 (95% CI 0.60 to 0.92); P = 0.007; 1719 participants; 11 comparisons; moderate-quality evidence). Assuming a baseline risk of 7% to 40% for RBC transfusion without iron supplementation, between 10 and 57 patients should be treated to avoid RBC transfusion in one patient.We found no evidence for a difference in the median time to hematopoietic response with addition of iron to ESAs (hazard ratio (HR) 0.93 (95% CI 0.67 to 1.28); P = 0.65; 1042 participants; seven comparisons; low-quality evidence). In subgroup analyses, RCTs in which dextran (HR 0.95 (95% CI 0.36 to 2.52); P = 0.92; 340 participants; three comparisons), sucrose iron (HR 1.15 (95% CI 0.60 to 2.21); P = 0.67; 102 participants; one comparison) and sulfate iron (HR 1.24 (95% CI 0.99 to 1.56); P = 0.06; 55 participants; one comparison) were used showed no evidence for difference between iron supplementation versus ESAs alone compared with RCTs in which gluconate (HR 0.78 (95% CI 0.65 to 0.94); P = 0.01; 464 participants; two comparisons) was used for median time to hematopoietic response (P = 0.02). There was no evidence for a difference between the subgroups of route of iron administration (P = 0.13) and types of ESAs (P = 0.46) for median time to hematopoietic response.Our results indicated that there could be improvement in the hemoglobin (Hb) levels with addition of iron to ESAs (mean difference (MD) 0.48 (95% CI 0.10 to 0.86); P = 0.01; 827 participants; seven comparisons; low-quality evidence). In RCTs in which IV iron was used there was evidence for a difference (MD 0.84 (95% CI 0.21 to 1.46); P = 0.009; 436 participants; four comparisons) compared with oral iron (MD 0.07 (95% CI -0.19 to 0.34); P = 0.59; 391 participants; three comparisons) for mean change in Hb level (P = 0.03). RCTs in which dextran (MD 1.55 (95% CI 0.62 to 2.47); P = 0.001; 102 participants; two comparisons) was used showed evidence for a difference with iron supplementation versus ESAs alone compared with RCTs in which gluconate (MD 0.54 (95% CI -0.15 to 1.22); P = 0.12; 334 participants; two comparisons) and sulfate iron (MD 0.07 (95% CI -0.19 to 0.34); P = 0.59; 391 participants; three comparisons) were used for mean change in Hb level (P = 0.007). RCTs in which epoetin was used showed evidence for a difference with iron supplementation versus ESAs alone (MD 0.77 (95% CI 0.25 to 1.29); P = 0.004; 337 participants; five comparisons) compared with darbepoetin use (MD 0.10 (95% CI -0.13 to 0.33); P = 0.38; 490 participants; two comparisons) for mean change in Hb level (P = 0.02).We found no evidence for a difference in quality of life with addition of iron to ESAs (standardized mean difference 0.01 (95% CI -0.10 to 0.12); P = 0.88; 1124 participants; three RCTs; high-quality evidence).We found no evidence for a difference in risk of grade III-IV thromboembolic events (RR 0.95 (95% CI 0.54 to 1.65); P = 0.85; 783 participants; three RCTs; moderate-quality evidence). The incidence of treatment-related mortality (TRM) was 0% (997 participants; four comparisons; high-quality evidence).Other common adverse events included vomiting, asthenia, and leukopenia, and were similar in both arms.Overall the risk of bias across outcomes was high to low. Since the included RCTs had shorter follow-up duration (up to 20 weeks), the long-term effects of iron supplementation are unknown. Our main reasons for downgrading the quality of evidence were inconsistency across the included studies and imprecision of results. AUTHORS' CONCLUSIONS Our systematic review shows that addition of iron to ESAs offers superior hematopoietic response, reduces the risk of RBC transfusions, and improves Hb levels, and appears to be well tolerated. None of the included RCTs reported overall survival. We found no evidence for a difference in quality of life with iron supplementation.
Collapse
Affiliation(s)
- Rahul Mhaskar
- University of South FloridaCenter for Evidence Based Medicine and Health Outcomes ResearchTampaFloridaUSA
| | - Hesborn Wao
- University of South FloridaCenter for Evidence Based Medicine and Health Outcomes ResearchTampaFloridaUSA
| | - Branko Miladinovic
- University of South FloridaCenter for Evidence Based Medicine and Health Outcomes ResearchTampaFloridaUSA
| | - Ambuj Kumar
- University of South FloridaCenter for Evidence Based Medicine and Health Outcomes ResearchTampaFloridaUSA
| | - Benjamin Djulbegovic
- Moffitt Cancer Center, Division of Oncologic Sciences, University of South FloridaDepartment of Blood and Marrow TransplantationTampaFloridaUSA
| | | |
Collapse
|
30
|
Meyer FRL, Steinborn R, Grausgruber H, Wolfesberger B, Walter I. Expression of platelet-derived growth factor BB, erythropoietin and erythropoietin receptor in canine and feline osteosarcoma. Vet J 2015; 206:67-74. [PMID: 26189892 PMCID: PMC4582422 DOI: 10.1016/j.tvjl.2015.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 12/12/2022]
Abstract
The discovery of expression of the erythropoietin receptor (EPO-R) on neoplastic cells has led to concerns about the safety of treating anaemic cancer patients with EPO. In addition to its endocrine function, the receptor may play a role in tumour progression through an autocrine mechanism. In this study, the expression of EPO, EPO-R and platelet-derived growth factor BB (PDGF-BB) was analysed in five feline and 13 canine osteosarcomas using immunohistochemistry (IHC) and reverse transcription polymerase chain reaction (RT-PCR). EPO expression was positive in all tumours by IHC, but EPO mRNA was only detected in 38% of the canine and 40% of the feline samples. EPO-R was expressed in all samples by quantitative RT-PCR (RT-qPCR) and IHC. EPO-R mRNA was expressed at higher levels in all feline tumours, tumour cell lines, and kidney when compared to canine tissues. PDGF-BB expression was variable by IHC, but mRNA was detected in all samples. To assess the functionality of the EPO-R on tumour cells, the proliferation of canine and feline osteosarcoma cell lines was evaluated after EPO administration using an alamarBlue assay and Ki67 immunostaining. All primary cell lines responded to EPO treatment in at least one of the performed assays, but the effect on proliferation was very low indicating only a weak responsiveness of EPO-R. In conclusion, since EPO and its receptor are expressed by canine and feline osteosarcomas, an autocrine or paracrine tumour progression mechanism cannot be excluded, although in vitro data suggest a minimal role of EPO-R in osteosarcoma cell proliferation.
Collapse
Affiliation(s)
- F R L Meyer
- Institute of Anatomy, Histology and Embryology, Department of Pathobiology, University of Veterinary Medicine, Veterinaerplatz 1, 1210 Vienna, Austria
| | - R Steinborn
- Genomics Core Facility, VetCore, University of Veterinary Medicine, Veterinaerplatz 1, 1210 Vienna, Austria
| | - H Grausgruber
- Division of Plant Breeding, University of Natural Resources and Life Sciences, Vienna, Konrad Lorenz-Strasse 24, 3430 Vienna, Austria
| | - B Wolfesberger
- Department for Companion Animals and Horses, University of Veterinary Medicine, Veterinaerplatz 1, 1210 Vienna, Austria
| | - I Walter
- Institute of Anatomy, Histology and Embryology, Department of Pathobiology, University of Veterinary Medicine, Veterinaerplatz 1, 1210 Vienna, Austria.
| |
Collapse
|
31
|
Steinmetz T, Kindler M, Lange O, Vehling-Kaiser U, Kuhn A, Hellebrand E. A prospective cohort study on the impact of darbepoetin alfa on quality of life in daily practice following anemia treatment guideline revisions. Curr Med Res Opin 2014; 30:1813-20. [PMID: 24849527 DOI: 10.1185/03007995.2014.924914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of darbepoetin alfa (DA) on hemoglobin (Hb) levels and quality of life (QoL) in cancer patients with anemia in current daily practice following several revisions of anemia treatment guidelines. METHODS This was a prospective, multi-center, observational study across Germany in non-myeloid cancer outpatients with chemotherapy-induced anemia treated with DA. Age, sex, cancer type, stage, and therapy, performance status, anemia status and treatment, and Hb concentrations were recorded for up to 18 weeks in a web-based registry. Optional QoL assessments were collected at baseline and at the end of DA treatment. MAIN RESULTS Of 984 eligible patients, 978 had complete anemia data, 492 also had complete QoL data. In the 978 patients, mean age was 64 (standard deviation, SD 12) years, 62% of patients were women. Breast (26%) and gastrointestinal (22%) cancer were most prevalent. Therapy was palliative in 44% of patients and initiated with curative intent in 29%. Mean baseline Hb was 9.5 (SD 0.9) g/dL, which increased by an average of 1.2 g/dL. In 67% of patients Hb increased either to 10-12 g/dL or by ≥2 g/dL; no Hb response was seen in 219 patients (22%); increases of 0 to 1, >1 to 2, and >2 g/dl were seen in 216 (22%), 265 (27%), and 278 (28%) patients, respectively. Anemia treatment did not result in any significant differences of performance status. However, QoL improvements were significantly greater in Hb responders, although a linear relationship with Hb increments was lacking. None of 47 fatal cases was considered related to treatment with DA. CONCLUSION Patients treated with DA in routine clinical practice had increases in Hb and reported improvement in QoL. Due to the uncontrolled design, no conclusions can be made regarding causality to treatment and the clinical relevance of the improvement.
Collapse
Affiliation(s)
- T Steinmetz
- Oncology outpatient clinic , Cologne , Germany
| | | | | | | | | | | |
Collapse
|
32
|
Debus J, Drings P, Baurecht W, Angermund R. Prospective, randomized, controlled, and open study in primarily inoperable, stage III non-small cell lung cancer (NSCLC) patients given sequential radiochemotherapy with or without epoetin alfa. Radiother Oncol 2014; 112:23-9. [PMID: 25129551 DOI: 10.1016/j.radonc.2014.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Induction chemotherapy is associated with anemia in non-small cell lung cancer (NSCLC) patients undergoing radiotherapy. This randomized, open-label study compared the effect of sequential radiochemotherapy (RCHT) versus RCHT + epoetin alfa (RCHT + EPO), with respect to 2-year overall survival (OS). MATERIAL AND METHODS Patients ⩾18 years received sequential RCHT; one arm also received EPO (chemotherapy day 1, when Hb<12 g/dL). Kaplan-Meier analysis with log-rank test, and Cox-regression methods were performed. RESULTS Of the 385 patients randomized (RCHT + EPO: n = 195; RCHT: n = 190), 78 (RCTH + EPO: 46 [23.6%]; RCHT: 32 [16.8%]) were anemic at baseline. Two-year OS was higher in RCHT + EPO-treated versus RCHT-treated (28.5% [95% CI: 22.2-35.1%] versus 20.6% [95% CI: 15.1-26.8%] [p = 0.2278]), and requirement for RBC transfusion was lower (24/195 [12.3%] versus 61/190 [32.1%]). In anemic (baseline) patients (post hoc analysis), median survival was shorter in RCTH-treated (212 days) versus RCHT + EPO-treated (343 days) (Hazard ratio = 1.62 [95% CI: 0.99-2.63], p = 0.0525). Adverse events were documented in 72.7% (RCHT + EPO: 75.0%; RCHT: 70.5%) patients, and thrombovascular events (TVEs) in 45 patients (RCHT + EPO: 16.7%; RCHT: 7.9%; p = 0.0099). CONCLUSIONS A statistically non-significant trend for 2-year OS was observed in a sub-group of EPO-treated NSCLC-patients with baseline anemia, although this trend was not maintained in the overall population with inoperable NSCLC.
Collapse
|
33
|
Nitz U, Gluz O, Zuna I, Oberhoff C, Reimer T, Schumacher C, Hackmann J, Warm M, Uleer C, Runde V, Dünnebacke J, Belzl N, Augustin D, Kates RE, Harbeck N. Final results from the prospective phase III WSG-ARA trial: impact of adjuvant darbepoetin alfa on event-free survival in early breast cancer. Ann Oncol 2014; 25:75-80. [PMID: 24356620 DOI: 10.1093/annonc/mdt505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND WSG-ARA plus trial evaluated the effect of adjuvant darbepoetin alfa (DA) on outcome in node positive primary breast cancer (BC). PATIENTS AND METHODS One thousand two hundred thirty-four patients were randomized to chemotherapy either with DA (DA+; n = 615) or without DA (DA-; n = 619). DA (500 µg q3w) was started at hemoglobin (Hb) levels <13.0 g/dl (<12 g/dl after DA label amendment) and stopped at Hb levels ≥14.0 g/dl (12 g/dl after label amendment). Primary efficacy end point was event-free survival (EFS); secondary end points were toxicity, quality of life (QoL) and overall survival (OS). RESULTS Venous thrombosis (DA+: 3.0%, DA-: 1.0%; P = 0.013) was significantly higher for DA+, but not pulmonary embolism (0.3% in both arms). Median Hb levels were stable in DA+ (12.6 g/dl) and decreased in DA- (11.7 g/dl). Hb levels >15 g/dl were reported in 0.8% of cycles. QoL parameters did not significantly differ between arms. At 39 months, DA had no significant impact on EFS (DA+: 89.3%, DA-: 87.5%; Plog-rank = 0.55) or OS (DA+: 95.5%, DA-: 95.4%; Plog-rank = 0.77). CONCLUSIONS DA treatment did not impact EFS or OS in routine adjuvant BC treatment.
Collapse
Affiliation(s)
- U Nitz
- Breast Center Niederrhein, Evangelic Hospital Bethesda, Moenchengladbach
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Bohlius J, Tonia T, Nüesch E, Jüni P, Fey MF, Egger M, Bernhard J. Effects of erythropoiesis-stimulating agents on fatigue- and anaemia-related symptoms in cancer patients: systematic review and meta-analyses of published and unpublished data. Br J Cancer 2014; 111:33-45. [PMID: 24743705 PMCID: PMC4090721 DOI: 10.1038/bjc.2014.171] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) reduce the need for red blood cell transfusions; however, they increase the risk of thromboembolic events and mortality. The impact of ESAs on quality of life (QoL) is controversial and led to different recommendations of medical societies and authorities in the USA and Europe. We aimed to critically evaluate and quantify the effects of ESAs on QoL in cancer patients. METHODS We included data from randomised controlled trials (RCTs) on the effects of ESAs on QoL in cancer patients. Randomised controlled trials were identified by searching electronic data bases and other sources up to January 2011. To reduce publication and outcome reporting biases, we included unreported results from clinical study reports. We conducted meta-analyses on fatigue- and anaemia-related symptoms measured with the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and FACT-Anaemia (FACT-An) subscales (primary outcomes) or other validated instruments. RESULTS We identified 58 eligible RCTs. Clinical study reports were available for 27% (4 out of 15) of the investigator-initiated trials and 95% (41 out of 43) of the industry-initiated trials. We excluded 21 RTCs as we could not use their QoL data for meta-analyses, either because of incomplete reporting (17 RCTs) or because of premature closure of the trial (4 RCTs). We included 37 RCTs with 10581 patients; 21 RCTs were placebo controlled. Chemotherapy was given in 27 of the 37 RCTs. The median baseline haemoglobin (Hb) level was 10.1 g dl(-1); in 8 studies ESAs were stopped at Hb levels below 13 g dl(-1) and in 27 above 13 g dl(-1). For FACT-F, the mean difference (MD) was 2.41 (95% confidence interval (95% CI) 1.39-3.43; P<0.0001; 23 studies, n=6108) in all cancer patients and 2.81 (95% CI 1.73-3.90; P<0.0001; 19 RCTs, n=4697) in patients receiving chemotherapy, which was below the threshold (≥ 3) for a clinically important difference (CID). Erythropoiesis-stimulating agents had a positive effect on anaemia-related symptoms (MD 4.09; 95% CI 2.37-5.80; P=0.001; 14 studies, n=2765) in all cancer patients and 4.50 (95% CI 2.55-6.45; P<0.0001; 11 RCTs, n=2436) in patients receiving chemotherapy, which was above the threshold (≥ 4) for a CID. Of note, this effect persisted when we restricted the analysis to placebo-controlled RCTs in patients receiving chemotherapy. There was some evidence that the MDs for FACT-F were above the threshold for a CID in RCTs including cancer patients receiving chemotherapy with Hb levels below 12 g dl(-1) at baseline and in RCTs stopping ESAs at Hb levels above 13 g dl(-1). However, these findings for FACT-F were not confirmed when we restricted the analysis to placebo-controlled RCTs in patients receiving chemotherapy. CONCLUSIONS In cancer patients, particularly those receiving chemotherapy, we found that ESAs provide a small but clinically important improvement in anaemia-related symptoms (FACT-An). For fatigue-related symptoms (FACT-F), the overall effect did not reach the threshold for a CID.
Collapse
Affiliation(s)
- J Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - T Tonia
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - E Nüesch
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - P Jüni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
- Department of Clinical Research, CTU Bern, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - M F Fey
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - M Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - J Bernhard
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| |
Collapse
|
35
|
Erythropoietin therapy after allogeneic hematopoietic cell transplantation: a prospective, randomized trial. Blood 2014; 124:33-41. [DOI: 10.1182/blood-2014-01-546333] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Key Points
Erythropoietin therapy can be effective to hasten erythroid recovery and reduce transfusion requirements after allogeneic HCT.
Collapse
|
36
|
Stirling RG, Evans SM, McLaughlin P, Senthuren M, Millar J, Gooi J, Irving L, Mitchell P, Haydon A, Ruben J, Conron M, Leong T, Watkins N, McNeil JJ. The Victorian Lung Cancer Registry Pilot: Improving the Quality of Lung Cancer Care Through the Use of a Disease Quality Registry. Lung 2014; 192:749-58. [DOI: 10.1007/s00408-014-9603-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/21/2014] [Indexed: 12/25/2022]
|
37
|
Frost J, Vermeulen IE, Beekers N. Anonymity versus privacy: selective information sharing in online cancer communities. J Med Internet Res 2014; 16:e126. [PMID: 24828114 PMCID: PMC4051744 DOI: 10.2196/jmir.2684] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 02/07/2014] [Accepted: 02/27/2014] [Indexed: 11/20/2022] Open
Abstract
Background Active sharing in online cancer communities benefits patients. However, many patients refrain from sharing health information online due to privacy concerns. Existing research on privacy emphasizes data security and confidentiality, largely focusing on electronic medical records. Patient preferences around information sharing in online communities remain poorly understood. Consistent with the privacy calculus perspective adopted from e-commerce research, we suggest that patients approach online information sharing instrumentally, weighing privacy costs against participation benefits when deciding whether to share certain information. Consequently, we argue that patients prefer sharing clinical information over daily life and identity information that potentially compromises anonymity. Furthermore, we explore whether patients’ prior experiences, age, health, and gender affect perceived privacy costs and thus willingness to share information. Objective The goal of the present study is to document patient preferences for sharing information within online health platforms. Methods A total of 115 cancer patients reported sharing intentions for 15 different types of information, demographics, health status, prior privacy experiences, expected community utility, and privacy concerns. Results Factor analysis on the 15 information types revealed 3 factors coinciding with 3 proposed information categories: clinical, daily life, and identity information. A within-subject ANOVA showed a strong preference for sharing clinical information compared to daily life and identity information (F1,114=135.59, P=.001, η2=.93). Also, adverse online privacy experiences, age, and health status negatively affected information-sharing intentions. Female patients shared information less willingly. Conclusions Respondents’ information-sharing intentions depend on dispositional and situational factors. Patients share medical details more willingly than daily life or identity information. The results suggest the need to focus on anonymity rather than privacy in online communities.
Collapse
Affiliation(s)
- Jeana Frost
- VU University Amsterdam, Amsterdam, Netherlands.
| | | | | |
Collapse
|
38
|
Kim A, Rivera S, Shprung D, Limbrick D, Gabayan V, Nemeth E, Ganz T. Mouse models of anemia of cancer. PLoS One 2014; 9:e93283. [PMID: 24681760 PMCID: PMC3969362 DOI: 10.1371/journal.pone.0093283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/28/2014] [Indexed: 12/21/2022] Open
Abstract
Anemia of cancer (AC) may contribute to cancer-related fatigue and impair quality of life. Improved understanding of the pathogenesis of AC could facilitate better treatment, but animal models to study AC are lacking. We characterized four syngeneic C57BL/6 mouse cancers that cause AC. Mice with two different rapidly-growing metastatic lung cancers developed the characteristic findings of anemia of inflammation (AI), with dramatically different degrees of anemia. Mice with rapidly-growing metastatic melanoma also developed a severe anemia by 14 days, with hematologic and inflammatory parameters similar to AI. Mice with a slow-growing peritoneal ovarian cancer developed an iron-deficiency anemia, likely secondary to chronically impaired nutrition and bleeding into the peritoneal cavity. Of the four models, hepcidin mRNA levels were increased only in the milder lung cancer model. Unlike in our model of systemic inflammation induced by heat-killed Brucella abortus, ablation of hepcidin in the ovarian cancer and the milder lung cancer mouse models did not affect the severity of anemia. Hepcidin-independent mechanisms play an important role in these murine models of AC.
Collapse
Affiliation(s)
- Airie Kim
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Seth Rivera
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Dana Shprung
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Donald Limbrick
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Victoria Gabayan
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Elizabeta Nemeth
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
39
|
Prognostic value of pretreatment hemoglobin level in patients with early cervical cancer. Obstet Gynecol Sci 2014; 57:28-36. [PMID: 24596815 PMCID: PMC3924748 DOI: 10.5468/ogs.2014.57.1.28] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/03/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the prognostic role of pretreatment anemia in patients with early cervical cancer who underwent radical hysterectomy. METHODS In this study, we retrospectively enrolled patients with early cervical cancer (International Federation of Obstetrics and Gynecology stage IB to IIA) who were treated at Samsung Medical Center, Seoul, Korea, from 1996 to 2007. RESULTS We retrospectively enrolled 805 patients. Median pretreatment hemoglobin (Hb) level was 12.8 g/dL (4.0-16.9) in all patients. Ninety-ninth out of 805 patients had pretreatment anemia (12.3%). Pretreatment anemia was significantly associated with large tumor size, advanced clinical stage, and parametrial invasion. In multivariate analysis, higher pretreatment Hb entailed better prognostic significance in disease free survival (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.078-0.99) but not in overall survival (HR, 0.94; 95% CI, 0.80-1.10). CONCLUSION In conclusion, we found that the negative association between pretreatment Hb level and tumor size and the impact of anemia before treatment on disease free survival adjusted for other factors including clinical stage and pathological findings in early stage cervical cancer.
Collapse
|
40
|
Littlewood TJ, Collins GP. Pharmacotherapy of anemia in cancer patients. Expert Rev Clin Pharmacol 2014; 1:307-17. [DOI: 10.1586/17512433.1.2.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
41
|
Littlewood T, Collins G. Epoetin alfa: basic biology and clinical utility in cancer patients. Expert Rev Anticancer Ther 2014; 5:947-56. [PMID: 16336085 DOI: 10.1586/14737140.5.6.947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anemia in cancer patients undergoing treatment is common and can cause debilitating symptoms such as fatigue and reduced exercise tolerance. The introduction of recombinant human erythropoietin represents a potential improvement in the treatment of this condition. Clinical studies in patients with solid tumors and nonmyeloid hematologic malignancies have convincingly shown an improvement in mean hemoglobin concentration, a reduction in transfusion requirement along with an improvement in quality of life scores, although an effect on survival is less clear. In myeloid disorders such as myelodysplasia, response to single-agent recombinant human erythropoietin is disappointing but significant synergism with granulocyte colony stimulating factor has been demonstrated and different dosing regimens may also improve response. Unfortunately, a significant proportion of patients remain refractory to treatment. Efforts have been made to identify treatable causes of erythropoietin refractoriness, such as functional iron deficiency, and concomitant intravenous iron supplementation does appear to improve response rates. The search for pretreatment factors that predict response has been largely disappointing, although a promising model for myelodysplasia has been developed that awaits large-scale evaluation. Recombinant human erythropoietin is well tolerated, although there were concerns in the late 1990s due to a rising incidence of pure red cell aplasia in chronic renal failure patients treated with subcutaneous Eprex (Ortho Biologics) in Europe. Since potentially contributory manufacturing processes have been identified and corrected, the incidence of this complication has been falling.
Collapse
Affiliation(s)
- Timothy Littlewood
- Department of Haematology, Level 4, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | | |
Collapse
|
42
|
Zhou B, Damrauer JS, Bailey ST, Hadzic T, Jeong Y, Clark K, Fan C, Murphy L, Lee CY, Troester MA, Miller CR, Jin J, Darr D, Perou CM, Levine RL, Diehn M, Kim WY. Erythropoietin promotes breast tumorigenesis through tumor-initiating cell self-renewal. J Clin Invest 2014; 124:553-63. [PMID: 24435044 DOI: 10.1172/jci69804] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/24/2013] [Indexed: 12/30/2022] Open
Abstract
Erythropoietin (EPO) is a hormone that induces red blood cell production. In its recombinant form, EPO is the one of most prescribed drugs to treat anemia, including that arising in cancer patients. In randomized trials, EPO administration to cancer patients has been associated with decreased survival. Here, we investigated the impact of EPO modulation on tumorigenesis. Using genetically engineered mouse models of breast cancer, we found that EPO promoted tumorigenesis by activating JAK/STAT signaling in breast tumor-initiating cells (TICs) and promoted TIC self renewal. We determined that EPO was induced by hypoxia in breast cancer cell lines, but not in human mammary epithelial cells. Additionally, we demonstrated that high levels of endogenous EPO gene expression correlated with shortened relapse-free survival and that pharmacologic JAK2 inhibition was synergistic with chemotherapy for tumor growth inhibition in vivo. These data define an active role for endogenous EPO in breast cancer progression and breast TIC self-renewal and reveal a potential application of EPO pathway inhibition in breast cancer therapy.
Collapse
|
43
|
Finkelmeier F, Bettinger D, Köberle V, Schultheiß M, Zeuzem S, Kronenberger B, Piiper A, Waidmann O. Single measurement of hemoglobin predicts outcome of HCC patients. Med Oncol 2013; 31:806. [PMID: 24326985 DOI: 10.1007/s12032-013-0806-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/04/2013] [Indexed: 12/29/2022]
Abstract
Anemia is a common complication in several types of cancer including hepatocellular carcinoma (HCC). The prognostic potential of hemoglobin (Hb) levels has not yet been investigated in HCC patients. One hundred and ninety-nine patients were prospectively recruited and Hb levels were determined. Hb levels were compared to the stages of liver cirrhosis and HCC stages. The association of the Hb levels and overall survival (OS) was assessed by univariate and multivariate Cox regression models. The relation of Hb levels and OS was further validated in an independent cohort of 87 HCC patients. Hb levels negatively correlated with the stage of liver cirrhosis (model of end stage liver disease score and Child-Pugh stage) and differed between stages of HCC. Low Hb levels (≤ 13 g/dl) were associated with higher mortality in the test [hazard ratio (HR) 2.422, 95 % confidence interval (CI) 1.357-4.322, P = 0.003] as well in the validation cohort (HR 2.486, 95 % CI 1.097-5.632, P = 0.029) in univariate Cox regression model. Low Hb levels were associated with mortality independently from the tumor stage, age, gender and the C-reactive protein levels in a multivariate Cox regression model. Anemia should be considered as a risk factor for mortality in HCC patients.
Collapse
Affiliation(s)
- Fabian Finkelmeier
- Medizinische Klinik 1, Schwerpunkt Gastroenterologie und Hepatologie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Beguin Y, Maertens J, Prijck B, Schots R, Seidel L, Bonnet C, Hafraoui K, Willems E, Vanstraelen G, Servais S, Jaspers A, Fillet G, Baron F. Darbepoetin-alfa and intravenous iron administration after autologous hematopoietic stem cell transplantation: a prospective multicenter randomized trial. Am J Hematol 2013; 88:990-6. [PMID: 23873823 DOI: 10.1002/ajh.23552] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/04/2013] [Accepted: 07/15/2013] [Indexed: 11/09/2022]
Abstract
We conducted a randomized study analyzing the impact of darbepoetin alfa (DA) administration with or without intravenous (i.v.) iron on erythroid recovery after autologous hematopoietic cell transplantation (HCT). Patients were randomized between no DA (Arm 1), DA 300 μg every 2 weeks starting on Day 28 after HCT (Arm 2), or DA plus i.v. iron 200 mg on Days 28, 42, and 56 (Arm 3). The proportion achieving complete hemoglobin (Hb) response within 18 weeks (primary end point) was 21% in Arm 1 (n = 24), 79% in Arm 2 (n = 25), and 100% in Arm 3 (n = 23; P < 0.0001). Erythropoietic response was shown to be significantly higher in Arm 3 (n = 46) than in Arm 2 (n = 50; P = 0.008), resulting in lower DA use, reduced drug costs, and improved quality of life scores, but the effect on transfusions was not significant. In multivariate analysis, DA administration (P < 0.0001), i.v. iron administration (P = 0.0010), high baseline Hb (P < 0.0001), and low baseline creatinine (P = 0.0458) were independently associated with faster achievement of complete Hb response. In conclusion, DA is highly effective to ensure full erythroid reconstitution after autologous HCT when started on Day 28 post-transplant. I.v. iron sucrose further improves erythroid recovery.
Collapse
Affiliation(s)
- Yves Beguin
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
- Giga‐ResearchUniversity of LiègeLiège Belgium
| | - Johan Maertens
- Clinical HematologyAcute Leukemia & Stem Cell Transplantation UnitUniversity Hospital GasthuisbergLeuven Belgium
| | - Bernard Prijck
- Department of MedicineDivision of HematologyCHR la CitadelleLiège Belgium
| | - Rik Schots
- Department of Clinical Hematology and Stem Cell LaboratoryUniversitair Ziekenhuis BrusselBrussel Belgium
| | | | - Christophe Bonnet
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
| | - Kaoutar Hafraoui
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
| | - Evelyne Willems
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
| | - Gaetan Vanstraelen
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
| | - Sophie Servais
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
- Giga‐ResearchUniversity of LiègeLiège Belgium
| | - Aurélie Jaspers
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
| | - Georges Fillet
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
- Giga‐ResearchUniversity of LiègeLiège Belgium
| | - Frederic Baron
- Department of MedicineDivision of HematologyCHU of LiègeUniversity of LiègeLiège Belgium
- Giga‐ResearchUniversity of LiègeLiège Belgium
| |
Collapse
|
45
|
Cömert M, Güneş AE, Sahin F, Saydam G. Quality of life and supportive care in multiple myeloma. Turk J Haematol 2013; 30:234-46. [PMID: 24385802 PMCID: PMC3878535 DOI: 10.4274/tjh.2012.0192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/01/2013] [Indexed: 12/01/2022] Open
Abstract
Multiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient’s quality of life and also can improve survival. The aim of this review is to highlight the relationship among life of quality, supportive care, and improvement in survival. Conflict of interest:None declared.
Collapse
Affiliation(s)
- Melda Cömert
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Ajda Ersoy Güneş
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Fahri Sahin
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| | - Güray Saydam
- Ege University School of Medicine, Department of Hematology, İzmir, Turkey
| |
Collapse
|
46
|
Abdel-Razeq H, Abbasi S, Saadi I, Jaber R, Abdelelah H. Intravenous iron monotherapy for the treatment of non-iron-deficiency anemia in cancer patients undergoing chemotherapy: a pilot study. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:939-44. [PMID: 24039403 PMCID: PMC3770628 DOI: 10.2147/dddt.s45674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Anemia in patients with cancer who are undergoing active therapy is commonly encountered and may worsen quality of life in these patients. The effect of blood transfusion is often temporary and may be associated with serious adverse events. Erythropoiesis-stimulating agents are not effective in 30%–50% of patients and may have a negative effect on overall survival. Aims To assess the efficacy and feasibility of intravenous iron therapy in patients with cancer who have non-iron-deficiency anemia and who are undergoing treatment with chemotherapy without the use of erythropoiesis-stimulating agents. Methods Adult patients with solid cancers and non-iron-deficiency anemia were included. Ferric sucrose at a dose of 200 mg was given in short intravenous infusions weekly for a total of 12 weeks. Hemoglobin level was measured at baseline, every 3 weeks, and 2 weeks after the last iron infusion (week 14). Adverse events related to intravenous iron were prospectively reported. Results Of 25 patients included, 19 (76.0%) completed at least three iron infusions and 14 (56.0%) finished the planned 12 weeks of therapy. The mean hemoglobin level of the 25 patients at baseline was 9.6 g/dL (median, 9.9 g/dL; range, 6.9 g/dL 10.9 g/dL). The mean change in hemoglobin level for the 15 patients who completed at least 9 treatments was 1.7 g/dL (median, 1.1 g/dL; range, −1.9 g/dL to 3.2 g/dL); it reached 2.1 g/dL (median, 1.3 g/dL; range, −0.2 g/dL to 4.6 g/dL; P = 0.0007) for the 14 patients who completed all 12 weekly treatments. Five (20.0%) patients were transfused and considered as treatment failures. No treatment-related adverse events were reported. Conclusion Intravenous iron treatment alone is safe and may reduce blood transfusion requirements and improve hemoglobin level in patients with cancer who are undergoing anticancer therapy. Further randomized studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
| | | | | | | | | |
Collapse
|
47
|
Pascual M, Bohle B, Alonso S, Mayol X, Salvans S, Grande L, Pera M. Preoperative administration of erythropoietin stimulates tumor recurrence after surgical excision of colon cancer in mice by a vascular endothelial growth factor–independent mechanism. J Surg Res 2013; 183:270-7. [DOI: 10.1016/j.jss.2012.12.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/14/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
|
48
|
Gascón P, Rodríguez CA, Valentín V, Mata JG, Carulla J, Cassinello J, Colomer R, Baró E. Usefulness of the PERFORM questionnaire to measure fatigue in cancer patients with anemia: a prospective, observational study. Support Care Cancer 2013; 21:3039-49. [PMID: 23793142 PMCID: PMC3789890 DOI: 10.1007/s00520-013-1862-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/21/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The PERFORM Questionnaire is a 12-item scale developed for assessing fatigue in cancer patients in the clinical practice. It has advantages over other tools in that it is short and includes beliefs and attitudes of patients about fatigue. It was psychometrically validated in cancer patients with and without anemia. PURPOSE We evaluated the usefulness of the PERFORM scale to measure fatigue in a large study focusing exclusively on anemic patients. METHODS This was an observational, multicenter, prospective, 3-month study in cancer patients with hemoglobin (Hb)≤11 g/dl. Fatigue was assessed using the PERFORM questionnaire. The overall score ranges from 12 (no fatigue) to 60 (maximum fatigue). RESULTS We included 667 patients: 54.1 % women, mean age 60 (standard deviation, 12) years. A highly significant, but mild correlation was observed between low baseline Hb and high patient perception of fatigue (r with PERFORM score=-0.215, p < 0.0001). Of the patients, 65.8 % improved Hb level during follow-up (increase of ≥1 g/dL and/or achieving >11 g/dL), which translated into a significant improvement in the PERFORM score [mean (95 % confidence interval (CI)] change, -1.2 (-0.04 to -2.4), whereas more fatigue was observed in patients without improvement in Hb [change (95 % CI) in PERFORM, +3.3 (1.5 to 5)]. In a multivariate linear regression analysis, the independent factors associated to fatigue at 3 months were a low Hb level, a low Karnofsky index, active chemotherapy, cancer treatment with palliative intention, and transfusion need in the last 3 months. CONCLUSIONS Minimal increases or decreases in Hb of ≥1 g/dL were associated with meaningful changes in patient-perceived fatigue as measured with the PERFORM questionnaire. In addition to anemia severity, other factors such as active chemotherapy and advanced disease contribute to perception of fatigue by cancer patients.
Collapse
Affiliation(s)
- Pere Gascón
- Hospital Clínic de Barcelona, Villarroel 170, ES-08036, Barcelona, Spain,
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Sparano J. Cytotoxic Therapy and Other Nonhormonal Approaches for the Treatment of Metastatic Breast Cancer. Breast Cancer 2013. [DOI: 10.1201/b14039-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
|
50
|
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.
Collapse
|