Correction of cancer anemia - Impact on disease course, prognosis and treatment efficacy, particularly for patients undergoing radiotherapy

Almost one cancer patient in two is anemic, with a correspondingly poorer prognosis and quality of life. A low blood hemoglobin level seems to directly impair treatment efficacy, particularly of radiotherapy, possibly because low tissue oxygenation causes a decrease in radiosensitivity. Tissue hypoxia may also facilitate tumor progression and impair the efficacy of cytostatic drugs. This constitutes a powerful rationale for correcting cancer anemia. Red cell transfusion is immediately effective, but carries risks of infection and immunosuppression. A safer alternative is recombinant human erythropoietin (rhEPO), which has already proved feasible and effective in correcting anemia and improving quality of life of cancer patients. Several ongoing radiotherapy studies are presently investigating whether rhEPO conclusively increases cancer cure rates. First results should be available in 2001. Given the efficacy of rhEPO to stimulate erythropoiesis and improve quality of life of cancer patients and its potential to enhance radiation's efficacy seem to earn it a firm place at least in the radiooncologist's arsenal.