Publication:
Erythropoietin or Darbepoetin for patients with cancer--meta-analysis based on individual patient data

cris.virtual.author-orcid0000-0002-8162-8910
cris.virtual.author-orcid0000-0002-6772-6346
cris.virtual.author-orcid0000-0001-7462-5132
cris.virtualsource.author-orcid2daf3ed0-9c65-46af-aca7-abb500f8f571
cris.virtualsource.author-orcidfb0eb07d-5423-4229-ba06-1a5eaf537fac
cris.virtualsource.author-orcid3b12b088-ef2b-4665-b7a5-265aa75ade43
cris.virtualsource.author-orcid3360179c-9be9-473b-ac03-a22eb128643e
cris.virtualsource.author-orcidd88a8532-b73c-448f-9c5e-6dd59004d437
cris.virtualsource.author-orcida47a659b-5a23-43fa-86e3-f9401108114c
datacite.rightsopen.access
dc.contributor.authorBohlius, Julia Friederike
dc.contributor.authorSchmidlin, Kurt
dc.contributor.authorBrillant, Corinne
dc.contributor.authorSchwarzer, Guido
dc.contributor.authorTrelle, Sven
dc.contributor.authorSeidenfeld, Jerome
dc.contributor.authorZwahlen, Marcel
dc.contributor.authorClarke, Mike J
dc.contributor.authorWeingart, Olaf
dc.contributor.authorKluge, Sabine
dc.contributor.authorPiper, Margaret
dc.contributor.authorNapoli, Maryann
dc.contributor.authorRades, Dirk
dc.contributor.authorSteensma, David
dc.contributor.authorDjulbegovic, Benjamin
dc.contributor.authorFey, Martin
dc.contributor.authorRay-Coquard, Isabelle
dc.contributor.authorMoebus, Volker
dc.contributor.authorThomas, Gillian
dc.contributor.authorUntch, Michael
dc.contributor.authorSchumacher, Martin
dc.contributor.authorEgger, Matthias
dc.contributor.authorEngert, Andreas
dc.date.accessioned2024-10-14T07:29:40Z
dc.date.available2024-10-14T07:29:40Z
dc.date.issued2009
dc.description.abstractBACKGROUND: Erythropoiesis-stimulating agents (ESAs) reduce anemia in cancer patients and may improve quality of life, but there are concerns that ESAs might increase mortality. OBJECTIVES: Our objectives were to examine the effect of ESAs and identify factors that modify the effects of ESAs on overall survival, progression free survival, thromboembolic and cardiovascular events as well as need for transfusions and other important safety and efficacy outcomes in cancer patients. SEARCH STRATEGY: We searched the Cochrane Library, Medline, Embase and conference proceedings for eligible trials. Manufacturers of ESAs were contacted to identify additional trials. SELECTION CRITERIA: We included randomized controlled trials comparing epoetin or darbepoetin plus red blood cell transfusions (as necessary) versus red blood cell transfusions (as necessary) alone, to prevent or treat anemia in adult or pediatric cancer patients with or without concurrent antineoplastic therapy. DATA COLLECTION AND ANALYSIS: We performed a meta-analysis of randomized controlled trials comparing epoetin alpha, epoetin beta or darbepoetin alpha plus red blood cell transfusions versus transfusion alone, for prophylaxis or therapy of anemia while or after receiving anti-cancer treatment. Patient-level data were obtained and analyzed by independent statisticians at two academic departments, using fixed-effects and random-effects meta-analysis. Analyses were according to the intention-to-treat principle. Primary endpoints were on study mortality and overall survival during the longest available follow-up, regardless of anticancer treatment, and in patients receiving chemotherapy. Tests for interactions were used to identify differences in effects of ESAs on mortality across pre-specified subgroups. The present review reports only the results for the primary endpoint. MAIN RESULTS: A total of 13933 cancer patients from 53 trials were analyzed, 1530 patients died on-study and 4993 overall. ESAs increased on study mortality (combined hazard ratio [cHR] 1.17; 95% CI 1.06-1.30) and worsened overall survival (cHR 1.06; 95% CI 1.00-1.12), with little heterogeneity between trials (I(2) 0%, p=0.87 and I(2) 7.1%, p=0.33, respectively). Thirty-eight trials enrolled 10441 patients receiving chemotherapy. The cHR for on study mortality was 1.10 (95% CI 0.98-1.24) and 1.04; 95% CI 0.97-1.11) for overall survival. There was little evidence for a difference between trials of patients receiving different cancer treatments (P for interaction=0.42). AUTHORS' CONCLUSIONS: ESA treatment in cancer patients increased on study mortality and worsened overall survival. For patients undergoing chemotherapy the increase was less pronounced, but an adverse effect could not be excluded.
dc.description.sponsorshipInstitut für Sozial- und Präventivmedizin (ISPM)
dc.description.sponsorshipUniversitätsklinik für Medizinische Onkologie
dc.identifier.doi10.7892/boris.30199
dc.identifier.isi000268037500030
dc.identifier.pmid19588423
dc.identifier.publisherDOI10.1002/14651858.CD007303.pub2
dc.identifier.urihttps://boris-portal.unibe.ch/handle/20.500.12422/103715
dc.language.isoen
dc.publisherWileyInterscience
dc.publisher.placeChichester
dc.relation.isbn19588423
dc.relation.ispartofCochrane database of systematic reviews
dc.relation.issn1469-493X
dc.relation.organizationDCD5A442BECFE17DE0405C82790C4DE2
dc.relation.organizationDCD5A442C448E17DE0405C82790C4DE2
dc.titleErythropoietin or Darbepoetin for patients with cancer--meta-analysis based on individual patient data
dc.typearticle
dspace.entity.typePublication
dspace.file.typetext
oaire.citation.issue3
oaire.citation.startPageCD007303
oaire.citation.volume2009
oairecerif.author.affiliationInstitut für Sozial- und Präventivmedizin (ISPM)
oairecerif.author.affiliationInstitut für Sozial- und Präventivmedizin (ISPM)
oairecerif.author.affiliationInstitut für Sozial- und Präventivmedizin (ISPM)
oairecerif.author.affiliationInstitut für Sozial- und Präventivmedizin (ISPM)
oairecerif.author.affiliationUniversitätsklinik für Medizinische Onkologie
oairecerif.author.affiliationInstitut für Sozial- und Präventivmedizin (ISPM)
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unibe.description.ispublishedpub
unibe.eprints.legacyId30199
unibe.journal.abbrevTitleCOCHRANE DB SYST REV
unibe.refereedtrue
unibe.subtype.articlejournal

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