Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012;17(5):715-24.
doi: 10.1634/theoncologist.2012-0024. Epub 2012 Apr 24.

The risk for anemia with targeted therapies for solid tumors

Sandro Barni  1 , Mary Cabiddu, Paolo Guarneri, Veronica Lonati, Fausto Petrelli
Affiliations
Review

The risk for anemia with targeted therapies for solid tumors

Sandro Barni et al. Oncologist. 2012.

Abstract

Background: Anemia is a common manifestation in patients with cancer. Little is known about the frequency of and risk for anemia with targeted therapies used to treat solid tumors.

Methods: We performed a meta-analysis of randomized controlled trials of solid tumors by comparing targeted therapy (alone or in combination) with standard therapy alone to calculate the incidence and relative risk (RR) for anemia events associated with these agents. Overall, 24,310 patients were included in the analysis.

Results: The addition of targeted therapies to standard treatment (chemotherapy or placebo/best supportive care) increased the risk for all grades of anemia by 7%. The RR for all grades (incidence, 44%) and grades 1-2 (incidence, 38.9%) of anemia was higher with biological therapies alone but not when combined with chemotherapy. The risk was significant for erlotinib, trastuzumab, and sunitinib. Bevacizumab was associated with a lower risk for anemia. Anti-epidermal growth factor receptor, anti-human epidermal growth factor receptor 2, anti-vascular endothelial growth factor receptors, and tyrosine kinase inhibitors predicted RRs of 1.24, 1.20, 0.82, and 1.33, respectively, and all of these values were significant.

Conclusion: Grade 1-2 anemia is frequently associated with biological agents. The risk is particularly associated with small-molecule tyrosine kinase inhibitors (gefitinib and erlotinib), breast cancer, and lung cancer. Erythropoiesis-stimulating agents are not labeled for use with targeted therapies (without chemotherapy) and the treatment is supportive only.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors indicated no financial relationships.

Figures

Figure 1.
Figure 1.
Meta-analysis of the overall relative risk for anemia (all grades) with targeted therapies (all agents separately) in 53 randomized studies. Abbreviations: CI, confidence interval; M-H, Mantel-Haenszel.
Figure 2.
Figure 2.
Meta-analysis of the overall relative risk for anemia (all grades) with targeted therapies alone (single-agent trials) versus control arm care in nine randomized studies. Abbreviations: CI, confidence interval; M-H, Mantel-Haenszel.
Figure 3.
Figure 3.
Meta-analysis of the overall relative risk for grade 1–2 anemia with targeted therapies alone (single-agent trials) versus control arm care in seven randomized studies. Abbreviations: CI, confidence interval; M-H, Mantel-Haenszel.
Figure 4.
Figure 4.
Funnel plot of the meta-analysis.
See this image and copyright information in PMC

References

    1. Hurter B, Bush NJ. Cancer-related anemia: Clinical review and management update. Clin J Oncol Nurs. 2007;11:349–359. - PubMed
    1. Payne J, Piper B, Rabinowitz I, et al. Biomarkers, fatigue, sleep, and depressive symptoms in women with breast cancer: A pilot study. Oncol Nurs Forum. 2006;33:775–783. - PubMed
    1. Cella D, Lai JS, Chang CH, et al. Fatigue in cancer patients compared with fatigue in the general United States population. Cancer. 2002;94:528–538. - PubMed
    1. NCCN Clinical Practice Guidelines in Oncology. [accessed December 16, 2011]. Available at http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf.
    1. Johnson DH, Fehrenbacher L, Novotny WF, et al. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 2004;22:2184–2191. - PubMed

MeSH terms

Substances