Erythropoietin (EPO) can improve local tumour control of pelvic cancer and boost overall survival, according to results of a phase III trial reported at the European Cancer Conference in Lisbon last year.
Anemia is very common in patients treated for cancer, and can be worsened by radiotherapy resulting in adverse effects on quality of life, disease control and survival. Two methods are available to combat anaemia, firstly, the immediate but transient restoration of haemoglobin concentration by blood transfusion and secondly, the use of EPO to boost production of red blood cells in a slow but steady manner.
In tests on laboratory rats, EPO has also been shown to enhance tumour radiosensitivity and to improve local control by radiotherapy (RT). EPO has been used to improve quality of life in cancer patients receiving RT, by relieving fatigue and breathlessness, but its effects on survival have not been directly demonstrated.
In a randomised study described by Dosia Antonadou from Metaxa Cancer Hospital in Greece, 385 patients with various types of pelvic malignant cancers were given conventional RT five times weekly with or without injection of 10 000U of EPO, mean haemoglobin concentrations returned to normal (12.09g/dL), compared to the lower values (10.1g/dL) still seen in the 195 patients not given EPO. After 2 years, 88% of tumours in the EPO group were controlled versus 77% in the RT alone group (P=0.007). After 4 years, local and distant recurrences were substantially reduced in the cervix uteri cancer patients, with 21% in the EPO+RT group compared to 27% in the RT group (P=0.041). Similar results were seen with endometrial cancer patients (6% in the EPO+RT group compared to 27% I the RT group; P=0.038). Progression free survival and overall survival were also substantially improved in the group receiving EPO.
“EPO administration results in a significant rise in haemoglobin concentration during radiotherapy”, explains Antonadou, “and we see improved tumour control, especially in patients with cancer of the cervix and endometrium”. She says “there was also a positive effect of EPO treatment on overall survival”.
(Source: The Lancet Oncology)