From the Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine
Authors' disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Fadlo R. Khuri, MD, 1365 Clifton Road NE, Bldg C, Atlanta, GA 30322; e-mail: kelly.may{at}emoryhealthcare.org
Overview: Erythropoietin-stimulating agents (ESAs) are indicated concomitantly with chemoradiotherapy for treatment of anemia in patients with nonmyeloid malignancies. Recent evidence has established that adverse outcomes are associated with use of ESAs in treatment of anemia in patients with cancer when used to maintain hemoglobin concentrations at higher than recommended levels. Several signaling pathways have been implicated in translating erythropoietin receptor stimulation to modify tumor behavior and response to chemoradiotherapy. In addition to verifying safety of ESAs for currently approved indications, continued research to establish key regulatory roles of erythropoietin within normal and cancerous tissues is essential. Until these questions are answered, strict evidenced-based criteria should be used when prescribing ESAs for patients with cancer.