PMID- 22277104
OWN - NLM
STAT- MEDLINE
DCOM- 20120906
LR  - 20220331
IS  - 1872-8332 (Electronic)
IS  - 0169-5002 (Linking)
VI  - 76
IP  - 3
DP  - 2012 Jun
TI  - Benefits and risks of using erythropoiesis-stimulating agents (ESAs) in lung 
      cancer patients: study-level and patient-level meta-analyses.
PG  - 478-85
LID - 10.1016/j.lungcan.2011.12.015 [doi]
AB  - In anemic patients receiving myelosuppressive chemotherapy, 
      erythropoiesis-stimulating agents (ESAs) raise hemoglobin levels and reduce 
      transfusion requirements, but ESA-related safety concerns exist. To evaluate ESA 
      benefits and risks in lung cancer, we conducted meta-analyses of data from 
      controlled ESA trials conducted in lung cancer patients. Study-level analyses 
      included controlled ESA trials reporting lung cancer mortality, identified from 
      the 2006 Cochrane ESA report and from a systematic search for studies published 
      through December 2010. Patient-level analyses included data from lung cancer 
      patients receiving chemotherapy in Amgen studies evaluating darbepoetin alfa (DA) 
      vs placebo. Study-level and patient-level analyses examined deaths, progression, 
      and transfusion incidence. Patient-level analyses also examined adverse events 
      (AEs) and fatigue. In a study-level meta-analysis of nine ESA studies of 2342 
      patients receiving chemotherapy, the ESA odds ratio (OR) was 0.87 (95% confidence 
      interval [CI] 0.69-1.09) for mortality; the overall random-effects risk 
      difference (95% CI) for mortality was -0.02 (-0.06, 0.02). The ESA OR (95% CI) 
      for disease progression in five chemotherapy studies reporting progression was 
      0.84 (0.65-1.09). The ESA odds ratio (95% CI) was 0.34 (0.28-0.41) for 
      transfusion incidence. In a patient-level meta-analysis of four studies 
      evaluating 1009 patients through follow-up, the median survival time was 41 weeks 
      with DA and 38 weeks with placebo. During the combined study and follow-up 
      periods, 80% of placebo-group patients and 74% of DA patients died (mortality 
      hazard ratio [HR] 0.90 [95% CI, 0.78-1.03] for DA); results were similar for 
      small cell lung cancer and non-small cell lung cancer. Overall, 87% of placebo 
      patients and 84% of DA patients progressed or died. Fewer DA patients had 
      transfusions (week 5 through end-of-study, DA 19%, placebo 43%). AEs included 
      thrombotic/embolic events (DA 10.5%, placebo 7.2%), cerebrovascular disorders (DA 
      3.7%, placebo 4.2%), pulmonary edema (DA 0.4%, placebo 1.0%) and pulmonary 
      embolism (DA 1.8%, placebo 0.6%). These meta-analyses suggest that ESAs reduce 
      transfusions without increasing mortality or disease progression in lung cancer 
      patients undergoing chemotherapy.
CI  - Copyright (c) 2012 Elsevier Ireland Ltd. All rights reserved.
FAU - Vansteenkiste, Johan
AU  - Vansteenkiste J
AD  - Respiratory Oncology Unit (Pulmonology), University Hospital Gasthuisberg, 
      Herestraat 49, B-3000 Leuven, Belgium. johan.vansteenkiste@uzleuven.be
FAU - Glaspy, John
AU  - Glaspy J
FAU - Henry, David
AU  - Henry D
FAU - Ludwig, Heinz
AU  - Ludwig H
FAU - Pirker, Robert
AU  - Pirker R
FAU - Tomita, Dianne
AU  - Tomita D
FAU - Collins, Helen
AU  - Collins H
FAU - Crawford, Jeffrey
AU  - Crawford J
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20120125
PL  - Ireland
TA  - Lung Cancer
JT  - Lung cancer (Amsterdam, Netherlands)
JID - 8800805
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Hematinics)
SB  - IM
MH  - Anemia/*chemically induced/*drug therapy/therapy
MH  - Antineoplastic Agents/*adverse effects/therapeutic use
MH  - Blood Transfusion
MH  - Disease Progression
MH  - Hematinics/adverse effects/*therapeutic use
MH  - Humans
MH  - Lung Neoplasms/*complications/drug therapy/mortality
MH  - Risk Assessment
EDAT- 2012/01/27 06:00
MHDA- 2012/09/07 06:00
CRDT- 2012/01/27 06:00
PHST- 2011/09/29 00:00 [received]
PHST- 2011/12/20 00:00 [revised]
PHST- 2011/12/27 00:00 [accepted]
PHST- 2012/01/27 06:00 [entrez]
PHST- 2012/01/27 06:00 [pubmed]
PHST- 2012/09/07 06:00 [medline]
AID - S0169-5002(11)00679-9 [pii]
AID - 10.1016/j.lungcan.2011.12.015 [doi]
PST - ppublish
SO  - Lung Cancer. 2012 Jun;76(3):478-85. doi: 10.1016/j.lungcan.2011.12.015. Epub 2012 
      Jan 25.