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Anemia Drug May Weaken Radiation Treatments for Head and Neck Cancers

A multi-center European study published in The Lancet (Vol. 362, No. 9392: 1255-1260) found that an experimental use of an anemia drug in some cancer patients going through radiation treatments may have worsened control of the cancer.

Experts said the results are unlikely to change the current US practice of administering the drug, called erythropoietin or epoetin, to patients whose anemia is causing problems like fatigue. But the study raises some important questions about what many doctors consider a potentially promising new application for this widely used drug.

Anemia drugs like epoetin increase levels of hemoglobin, the compound in red blood cells that carries oxygen to the tissues. Because radiation is more effective against cells with high oxygen concentrations, many researchers have theorized that giving patients these drugs would raise the oxygen level in tumors and help patients respond better to their treatment.

In the new study, however, the opposite happened.

"It's a very disappointing result," said Jerome Seidenfeld, PhD, associate director of the Technology Evaluation Center of the Blue Cross and Blue Shield Association, who helped compile guidelines for epoetin use published by the American Society of Clinical Oncology.

Researchers led by Michael Henke, MD, of the University of Freiburg in Germany compared 351 head and neck cancer patients who began receiving either epoetin-beta or a placebo about two weeks before radiotherapy began, and continued the treatment throughout the course of radiation.

The researchers found that patients on epoetin-beta fared worse in terms of tumor control and survival than those given a placebo, although their hemoglobin levels did increase.

The study raises many important questions, experts said.

Might the negative effect on tumor control also apply to patients with other kinds of cancer who are receiving anemia treatment with chemotherapy, too? Is the impairment of tumor control related to the drug itself, or to the increase of hemoglobin caused by the drug?

More research is needed to make those determinations.

"I think one should always interpret a single clinical trial in just that light: It's a single clinical trial," said Douglas Rizzo, MD, an associate professor of medicine at the Medical College of Wisconsin and another member of the ASCO epoetin committee.

He noted that many of the patients in this trial did not complete it correctly -- their radiation treatments were not given properly, or they had medication errors. That could have affected the strength of the statistical analysis, he said.

In addition, many patients in this trial had hemoglobin levels higher than what US doctors generally use as a guide to determine who should get epoetin.

Rizzo suggested it was premature to generalize the results of this study to patients with other cancer types or those receiving chemotherapy. He noted that in an earlier study of cervical cancer patients receiving both chemotherapy and radiation, epoetin did appear to improve relapse-free survival.

"I don't know that this should substantially change practice for patients with substantial fatigue and low hemoglobin," he said.

Seidenfeld agreed. "What remains true is that ...treating (anemic patients) with erythropoietin is going to make them feel better and is going to reduce the likelihood that they'll need a transfusion down the line," he said.