Anemia Drugs for Cancer Patients Increase Death Risk

Erythropoiesis-stimulating agents also boost risk of blood clots, study says

By Serena Gordon
HealthDay Reporter

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TUESDAY, Feb. 26 (HealthDay News) -- Drugs designed to fight fatigue and other symptoms associated with cancer treatment-related anemia may do more harm than good, especially if given in the wrong doses.

The drugs -- erythropoiesis-stimulating agents (ESAs) -- increase the risk of death by 10 percent and the risk of blood clots known as venous thromboembolisms (VTE) by 57 percent, according to a review published in the Feb. 27 issue of the Journal of the American Medical Association.

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"What we've done here is put together the totality of the evidence and found two things that are concerning: The increased risk of VTE and the increased risk of mortality," said the review's lead author, Dr. Charles Bennett, the A.C. Beuhler professor of geriatric medicine at Northwestern University's Feinberg School of Medicine.

ESAs -- erythropoietin (Epogen, Procrit) and darbepoetin (Aranesp) -- work by stimulating the bone marrow to produce new red blood cells, according to the U.S. National Institutes of Health. They are used to treat anemia caused by chemotherapy and to treat anemia in people with chronic kidney disease who are on dialysis.

This isn't the first time health experts have raised concerns about these medications. In kidney patients, past research has found that if these drugs are used to raise hemoglobin levels above 12 grams per deciliter of blood, the risk of death increases. And past cancer research has suggested that the drugs may be associated with more rapid tumor growth and an increased risk of death.

Due to these concerns, the U.S. Food and Drug Administration last year had the drugs' manufacturers add a "black box" warning to the medications. The warning indicates that the medications should be used at the lowest possible doses to avoid risks such as blood clots, heart attacks, stroke, congestive heart failure, increased tumor growth and an increased risk of death. The FDA also recommended that the medications be prescribed at the lowest doses possible because trials generally indicated an increased risk when blood levels were raised above 12 grams per deciliter.

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