Эритропоэтин не эффективен при опухоль-индуцированных анемиях

[Dr.Vad]

Эритропоэтин не эффективен при неопластических анемиях, вызванных самой опухолью (а не применением химиотерапии) и, похоже, ухудшает выживаемость таких пациентов:

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

А теперь и доказательство вышеуказанного в виде результата РКИ:

J Clin Oncol. 2008 Jan 28

Darbepoetin Alfa for the Treatment of Anemia in Patients With Active Cancer Not Receiving Chemotherapy or Radiotherapy: Results of a Phase III, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study.

Smith RE Jr, Aapro MS, Ludwig H, Pintér T, Smakal M, Ciuleanu TE, Chen L, Lillie T, Glaspy JA.

South Carolina Oncology Associates, Columbia, SC; Amgen Inc, Thousand Oaks; University of California, Los Angeles, School of Medicine, Los Angeles, CA; Clinique de Genolier, Genolier, Switzerland; Wilhelminenspital, 1.Medizinische Abteilung mit Onkologie, Vienna, Austria; Petz Aladar County Teaching Hospital, Gyor, Hungary; Ustav Onkologie a Pneumologie Na Plesi, Onkologicke oddeleni, Plesi, Czech Republic; and Institutul Oncologic "Ion Chiricuta," Cluj-Napoca, Romania.

PURPOSE: The efficacy and safety of darbepoetin alfa (DA) for treating patients with active cancer and anemia not receiving or planning to receive cytotoxic chemotherapy or myelosuppressive radiotherapy was evaluated. PATIENTS AND METHODS: Patients with active cancer and anemia not receiving or planning to receive chemotherapy or radiotherapy were enrolled onto a phase III, multicenter, randomized, placebo-controlled study and administered placebo or DA 6.75 microg/kg every 4 weeks (Q4W) for up to 16 weeks with a 2-year follow-up for survival. Patients who completed 16 weeks of treatment could receive the same treatment as randomized Q4W for an additional 16 weeks. The primary end point was all occurrences of transfusions from weeks 5 through 17; safety end points included incidence of adverse events and survival. RESULTS: The incidence of transfusions between weeks 5 and 17 was lower in the DA group but was not statistically significantly different from that of placebo. DA was associated with an increased incidence of cardiovascular and thromboembolic events and more deaths during the initial 16-week treatment period. Long-term survival data demonstrated statistically significantly poorer survival in patients treated with DA versus placebo (P = .022). This effect varied by baseline covariates including, sex, tumor type, and geographic region; statistical significance diminished (P = .12) when the analysis was adjusted for baseline imbalances or known prognostic factors. CONCLUSION: DA was not associated with a statistically significant reduction in transfusions. Shorter survival was observed in the DA arm; thus, this study does not support the use of erythropoiesis-stimulating agents in this subset of patients with anemia of cancer.

[alex950]

А как Вы думаете, с чем тут может быть связано ухудшение выживаемости?

[Dr.Vad]

Судя по статистике, усиливалась гиперкоагуляция (которая и так имеется на фоне онкопроцесса) и склонность к тромбообразованию:...rhEPO therapy also has been identified as a strong risk factor for venous thromboembolism in cancer patients undergoing chemotherapy...

Этот эффект также был замечен и в эксперименте:...we demonstrate that rhEPO administration in the rat increases systemic blood pressure, reduces regional renal blood flow, and increases platelet counts and procoagulant activities...

(Cytoprotective doses of erythropoietin or carbamylated erythropoietin have markedly different procoagulant and vasoactive activities. Proc Natl Acad Sci U S A. 2006 Apr 11;103(15):5965-70.)

[Doxtur]

Согласен,
к тому-же Epo стимулирует Epo-рецепторы опухолевых клеток, что приводит к усилению миграции клеток, ангиогенезу и подавлению апоптоза.
Не рекомендуется использование при лечении не-гематологических злокачественных процессов.