The Risk for Anemia with Targeted Therapies for Solid Tumors

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

Diagnosis and treatment of cancer‐related anemia

“…This may result, in part, due to hyperproliferation of bone marrow blast cells which “crowd out” the non‐malignant cell population thus preventing normal erythroid blast‐forming units and islands from interacting with stem cell factor and bone marrow stromal cells which are thought to be necessary to maintain their differentiation, growth, and division . Additionally, mutations in or therapy‐related inhibition of the intracellular domain of c‐kit (CD117) may also be partly responsible for reduced erythropoiesis by reducing c‐kit‐dependent phosphorylation and the intracellular interaction between c‐kit and the tyrosine kinase domain of the erythropoietin receptor .…”

“…We currently consider ESA therapy for patients receiving palliative, myelosuppressive chemotherapy with a Hb <10 g/dL and without absolute iron deficiency . It is important to note that although newer targeted therapies such as sunitinib, erlotinib, or trastuzumab commonly contribute to anemia, the ESA package labels do not mention whether these are included under the definition of myelosuppressive agents . When dosing ESA therapy, we prefer subcutaneous (SQ) over the IV route, because doses given IV are cleared from the plasma more quickly and are therefore less effective .…”

Safety profile of combined therapy inhibiting EFGR and VEGF pathways in patients with advanced non‐small‐cell lung cancer: A meta‐analysis of 15 phase II/III randomized trials

“…The association between anemia and targeted therapy is noteworthy. A previous meta‐analysis demonstrated that there was most likely an association between targeted agents and the type of cancer . Unfortunately, their study did not probe into the association between vandetanib and anemia.…”

“…A previous meta-analysis demonstrated that there was most likely an association between targeted agents and the type of cancer. 48 Unfortunately, their study did not probe into the association between vandetanib and anemia. This finding needs to be further investigated in the future.…”

The impact of anemia on microsurgical breast reconstruction complications and outcomes

“…Appropriate and adequate blood flow and oxygen delivery is paramount to free flap viability and success. While these procedures rarely involve significant blood loss, many patients present with pre‐existing anemia related to their cancer or its treatment and may develop a state of postoperative anemia following surgery . Anemia has long been discussed both as a potential advantage to the free flap, but as a complicating issue to the patient.…”