Whether or not to treat a cancer patient with erythropoietin depends on consideration of benefits vs risks, indications, contraindications, and costs.
Indications for erythropoietin therapy may include:
(1) hypoplastic marrow secondary to chemoradiation
(2) chronic kidney disease
Benefits of erythropoietin may include:
(1) decrease in need for transfusion
(2) decrease in anemia-related fatigue, with improved quality of life
Hazards of erythropoietin therapy
(1) possible stimulation of tumor growth (in tumor cells with an erythropoietin therapy) and/or angiogenesis
(2) failure to address other causes of anemia
(3) anti-apoptotic action on non-hematopoietic cells
Uncertainties:
(1) how much erythropoietin therapy contributes to improved survival
(2) economic benefit of potentially expensive long-term therapy
Testing that may help in decision making:
(1) serum erythropoietin concentrations prior to therapy
(2) testing for erythropoietin receptors on cancer cells
Clinical rules proposed by Debeljak et al (in the conclusion):
(1) if the patient is being treated for cure, then avoid the use of erythropoietin if possible.
(2) if the patient is not being treated for cure, then consider cautious use.
