内容紹介
Treatment of Chemotherapy-Induced Anemia
Summary
The prognosis of cancer patients with anemia is poor. In Japan, these patients are treated only with red blood cell transfusions, and doctors cannot use erythropoiesis stimulating agents(ESAs)such as epoetin and darbepoetin. On the other hand, ESAs are widely used in the USA and Europe to treat patients with chemotherapy-induced anemia. However, the results of randomized controlled trials(RCTs)and meta-analysis have suggested that the use of ESAs was correlated with increasing incidence of venous thromboembolism(VTE)and mortality. The American Society of Clinical Oncology(ASCO)and the American Society of Hematology(ASH)guidelines, revised in 2010, recommend the minimal use of ESAs for patients with chemotherapy-induced anemia, except for anemic cancer patients who are not currently receiving chemotherapy. A change in the target hemoglobin(Hb)level to achieve a concentration of 12 g/dL was recommended in 2007 as the lowest concentration required to avoid transfusions. We discuss the cause of anemia in cancer patients, and examine the current state of the clinical use and problems associated with ESAs.
要旨
がん患者の貧血は予後不良因子であることが知られている。わが国におけるがん患者の貧血に対する治療は唯一輸血のみであり,赤血球造血刺激因子製剤(ESAs)の使用は許容されていない。一方で,欧米各国では化学療法に起因する貧血に対してESAsは広く用いられている。本稿ではがん患者の貧血の原因に触れつつ,特にESAs治療に関する現況に関して米国臨床腫瘍学会ガイドラインの概説などを踏まえつつ触れていきたい。
目次
Summary
The prognosis of cancer patients with anemia is poor. In Japan, these patients are treated only with red blood cell transfusions, and doctors cannot use erythropoiesis stimulating agents(ESAs)such as epoetin and darbepoetin. On the other hand, ESAs are widely used in the USA and Europe to treat patients with chemotherapy-induced anemia. However, the results of randomized controlled trials(RCTs)and meta-analysis have suggested that the use of ESAs was correlated with increasing incidence of venous thromboembolism(VTE)and mortality. The American Society of Clinical Oncology(ASCO)and the American Society of Hematology(ASH)guidelines, revised in 2010, recommend the minimal use of ESAs for patients with chemotherapy-induced anemia, except for anemic cancer patients who are not currently receiving chemotherapy. A change in the target hemoglobin(Hb)level to achieve a concentration of 12 g/dL was recommended in 2007 as the lowest concentration required to avoid transfusions. We discuss the cause of anemia in cancer patients, and examine the current state of the clinical use and problems associated with ESAs.
要旨
がん患者の貧血は予後不良因子であることが知られている。わが国におけるがん患者の貧血に対する治療は唯一輸血のみであり,赤血球造血刺激因子製剤(ESAs)の使用は許容されていない。一方で,欧米各国では化学療法に起因する貧血に対してESAsは広く用いられている。本稿ではがん患者の貧血の原因に触れつつ,特にESAs治療に関する現況に関して米国臨床腫瘍学会ガイドラインの概説などを踏まえつつ触れていきたい。