Emerging topics in anaemia and cancer

Bythropoiesis-stimulating agents (ESAs) increase red blood cell (RBC) production by activating the erythropoietin receptor on erythrocytic progenitor cells. ESAs are approved in the United States and Europe for treating anaemia in cancer patients receiving chemotherapy. ESA safety issues include thromboembolic events and there have been concerns about disease progression and/or mortality in cancer patients. This educational supplement paper is based on two recently published papers. We review both clinical trial data on ESAs and disease progression and preclinical data on how ESAs could affect tumour growth. We conclude that ESAs may have little effect on disease progression in chemotherapy patients, and preclinical data indicate a direct or indirect effect of ESAs on tumour growth is not strongly supported. We also summarise the mechanisms and clinical consequences of iron deficiency and anaemia in cancer patients. Randomised clinical trials have shown superior efficacy of iv. iron over oral or no iron in reducing blood transfusions, increasing haemoglobin, and improving quality of life in ESA-treated anaemic advanced cancer patients. Furthermore, iv. iron without additional ESA should be evaluated as potential treatment in patients with chemotherapy induced anaemia. At recommended doses, i.v. iron is well tolerated, particularly compared with oral iron, but caution should be used in some specific situations.