LOS ANGELES—Preclinical and early clinical evidence indicates that correcting anemia might prolong survival in cancer patients, reported John Glaspy, MD, MPH, at the Fifth Quality of Life in Oncology Symposium in Pasadena, California. He called for more prospective randomized trials specifically designed to investigate the effect of anemia on survival.
Dr. Glaspy is medical director of the Boyer Oncology Clinic and professor of medicine at the University of California School of Medicine in Los Angeles. He served as co-chair of the symposium, which was supported by an unrestricted educational grant from Amgen.
"In cancer patients, anemia might contribute to disease progression by decreasing the efficacy of radiation therapy, by impacting the biology of cancer to favor a higher virulence, and by decreasing the functional status of our patients so that they don’t receive optimal treatment," he explained.
A Newer Model
The newer model of the anemia of chronic disease contrasts with the traditional model in two very important ways—by proposing a correlation between the degree of anemia and the severity of disease and predicting that specific treatment of anemia might alter the course of disease. "This has obvious implications for the importance of treatment," Dr. Glaspy asserted.
In a study of rats with induced anemia, researchers looked into which cytokines mediate the anemia of chronic disease and found "an exuberant IL-1 and TNF response on the part of inflammatory cells," Dr. Glaspy said. In one arm of the study, anemic rats treated with darbepoetin alfa(Drug information on darbepoetin alfa) (Aranesp) had an inflammatory reaction of macrophages that was close to the control group. "This is one piece of a very large body of evidence that the anemia of chronic disease may contribute to the inflammatory milieu that results in a downhill spiral," Dr. Glaspy said.
A literature search would reveal an emerging body of epidemiology evidence that the anemias of chronic diseases are predictive of poor outcomes for those diseases, Dr. Glaspy said. These diseases include inflammatory bowel disease, liver disease, rheumatoid arthritis, systemic lupus erythematosus, HIV, congestive heart failure, and several types of cancer. This suggests that anemia may simply be a marker for the severity of disease or a contributing factor to the outcome.
