CLINICAL PRACTICE OF RECOMBINANT HUMAN ERYTHROPOETIN IN CANCER RELATED ANEMIA

Anemia is a complication commonly encountered in malignancy, especially of hematological origin, either at presentation or during the course of treatment.  Anemia of chronic disease, a condition characterized by disordered iron metabolism, shortened RBC half-life and inefficient erythropoiesis, is the major contributor to cancer anemia. Anemia effects up to 90% of Cancer patients with more than 60% requiring blood transfusion during or after treatment with the advent of recombinant human Erythropoietin (rHuEPO), an alternative to red blood cell transfusion has become available rHuEPO is now widely used in Cancer patients, as it improves hematocrit, lowers blood transfusion requirements and improves quality of life.  So far, three drugs have been approved for the treatment of anemia in patients with malignancies (epoetin Alfa epoetin Beta and darbopoetin Alfa).  New concepts for the cure of erythropoietin in cancer patients include 3 and 4 weekly dosing, as well as loading dose concepts.  Although three rHuEPOs act on the same erythropoietin receptors, there are some variations on the degree of glycolylation, which lead to the differences in the pharmacokinetics and pharmacodynamics among the RhuEPOs. The cost effectiveness and medical justification of the administration of RHuEPO in tumor patients with respect to its positive effects on tumor oxygenation, tumor growth inhibition and support of chemo and radiotherapy is still a matter of debate.  The largest systematic review on the use of erythropoietin in cancer patients undergoing treatment indicates a suggestive but not significant survival advantage of erythropoietin treated patients.  Besides highlighting both the historical and functional aspects of RHuEPO, this review discusses the applications of RHUEPO in oncology.