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Researchers Urge Caution in Using ESAs for Cancer-Related Anemia

, Dr. Lappin and coauthors draw attention to an additional possibility: that ESAs could promote cancer growth. Several studies have identified molecular receptors of erythropoietin in the endothelial cells lining blood vessels and possibly in tumor cells as well. Because of their genetically modified characteristics, ESAs may have stronger effects on these receptors than natural erythropoietin does. If so, then it is possible that ESAs may promote abnormal formation of new blood vessels. This process, called neovascularization, is a key event in cancer growth and progression.

To clarify the adverse effects of ESA treatment in cancer patients, it will be necessary to find out more about how the erythropoietin receptor functions in cancers, the authors believe. Recent studies at their laboratory suggest that erythropoietin may have abnormal effects on the erythropoietin receptors in cultured tumor cells. If this also happens in tumor tissues, it may contribute to the adverse effects of ESAs in patients with cancer-related anemia.

Pending further scientific data, a closer look at the available clinical research may offer important insights. Studies in patients with kidney disease have suggested that using erythropoietin to raise hemoglobin above the usual target level of 12 grams per deciliter (g/dL) is not helpful, and possibly harmful.

"Additional research is urgently needed to determine the effects of ESAs on risk of thrombosis, rate of tumor growth and neovascularization both in vitro and in vivo," Dr. Lappin and colleagues write. Until such studies are done, they believe that ESA treatment for cancer-related anemia should be undertaken cautiously -- and no higher than the 12 g/dL target level.

The new article, entitled, "Warning Flags for Erythropoiesis Stimulating Agents and Cancer Associated Anemia," is available online at http://theoncologist.alphamedpress.org and
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