Epoetin beta for the treatment of chemotherapy-induced anemia: an update

Abstract

Epoetin beta belongs to the class of erythropoiesis-stimulating agents (ESAs) that are currently available to treat anemic patients receiving chemotherapy. Chemotherapy-induced anemia affects a high percentage of cancer patients and, due to its negative effects on disease outcome and the patient's quality of life, should be treated when first diagnosed. Initial trials with ESAs have shown efficacy in improving quality of life and reducing the need for blood transfusions in patients with chemotherapy-induced anemia. However, recent meta-analyses have provided conflicting data on the impact of ESAs on survival and tumor progression. Here we provide an overview of these recent data and review the role of epoetin beta in the treatment of chemotherapy-induced anemia over the past 20 years.

Keywords: anemia; cancer; chemotherapy; epoetin beta; erythropoietin; treatment.

Figure 1

Hemoglobin level of patients at enrollment according to tumor type. Notes: Data based on the evaluable population (n=14,912). Republished with permission of European Journal of Cancer, from The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients, Ludwig H, Van Belle S, Barrett-Lee P, et al, 40(15):2004; permission conveyed through Copyright Clearance Center, Inc. Abbreviation: GI, gastrointestinal.

Figure 2

Schematic representation of the erythropoiesis process. Note: Republished with permission of Blood: American Society of Hematology, from From stem cell to red cell: regulation of erythropoiesis at multiple levels by multiple proteins, RNAs, and chromatin modifications, Hattangadi SM, Wong P, Zhang L, Flygare J, Lodish HF, 118(24):2011; permission conveyed through Copyright Clearance Center, Inc. Abbreviations: CFU-GEMM, colony forming unit-granulocyte, erythrocyte, monocyte, megakaryocyte; BFU-E, burst-forming unit-erythroid; CFU-E, colony forming unit-erythroid; IL, interleukin; GM-CSF, granulocyte macrophage-colony stimulating factor; SCF, stem cell factor; BMP, bone morphogenetic protein; Epo, erythropoietin.

Figure 3

Kaplan–Meier curve showing transfusion-free survival in all patients. Note: Copyright © 2006. The International Institute of Anticancer Research. Reproduced from Boogaerts M, Oberhoff C, Ten Bokkel Huinink W, Nowrousian MR, Hayward CR, Burger HU. Epoetin beta (NeoRecormon) therapy in patients with solid tumours receiving platinum and non-platinum chemotherapy: a meta-analysis. Anticancer Res. 2006;26(1B):479–484.