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The 24th National Conference on Clinical Oncology and the 2021 CSCO Academic Annual Conference will be held on September 25-29, 2021.
At this conference, Professor Zhou Guoren from Jiangsu Cancer Hospital conducted the "Hazards and Full Management of Tumor-related Anemia" In the theme report, Yimaitong organizes the main content as follows
.
Cancer-associated anemia (CRA) mainly refers to the anemia that occurs in tumor patients during the development of their disease and during treatment.
It is one of the common accompanying diseases of malignant tumors.
About 30%-90% of tumor patients will develop anemia.
.
Professor Zhou Guoren introduced the harm of CRA and the optimal management of erythropoietin (EPO)-CRA in two aspects
.
The harm of CRA Professor Zhou Guoren said that the related factors that cause CRA include insufficient nutritional intake, relatively insufficient EPO production, iron metabolism disorders, and various treatment methods (chemotherapy, radiotherapy, surgical treatment, etc.
)
.
It should be noted that targeted therapy and immunotherapy can also cause CRA.
In large clinical trials, grade 1-4 anemias of targeted therapy drugs PARP inhibitors olaparib, lukapanib and niraparib occurred The rates are 90%, 37% and 50% respectively
.
The CheckMate 078 study showed that the incidence of anemia caused by nivolumab is approximately 4%
.
The results of the Phase I study of Karelizumab showed that the incidence of anemia was 11%, of which grades 3-4 accounted for 2%
.
CRA is more harmful and has a negative impact on the anti-tumor effect, overall survival (OS) and quality of life of patients
.
CRA can aggravate tumor hypoxia, leading to radioresistance and chemotherapy drug resistance.
A study involving 140 patients with non-small cell lung cancer (NSCLC) receiving chemotherapy showed that anemia before and during chemotherapy significantly reduced patients’ anti-tumor resistance The treatment effect shows that anemia reduces the sensitivity of chemotherapy and affects the effect of chemotherapy
.
In an EOX regimen (epirubicin, oxaliplatin, and capecitabine) in the treatment of 58 patients with advanced gastric cancer, as well as an evaluation of hemoglobin (Hb) changes and anemia and survival during baseline and concurrent radiotherapy and chemotherapy Studies on the relationship and its impact on the prognosis of NSCLC patients have shown that anemia significantly shortens the median progression-free survival (PFS) and median OS of tumor patients
.
Professor Zhou Guoren also emphasized that anemia is an independent factor influencing the poor prognosis of gastric cancer.
Correcting anemia is expected to improve the prognosis
.
In addition, anemia can also reduce the quality of life of patients.
A prospective study involving 218 cancer patients (64% of patients with anemia) showed that patients with anemia had significantly lower quality of life scores than normal patients (135 vs 150)
.
Therefore, Professor Zhou Guoren said here that correcting anemia is expected to improve the treatment effect and prognosis of cancer patients
.
The preferred treatment for EPO-CRA throughout the management of CRA The most commonly used and most studied erythropoiesis stimulant (ESA) is EPO
.
EPO can be used for the treatment of anemia in different tumor treatment stages (including neoadjuvant chemotherapy [+radiotherapy], perioperative period, postoperative chemotherapy [+radiotherapy], palliative treatment)
.
Professor Zhou Guoren said that how to standardize the use of EPO is an important skill that clinicians need to master
.
During neoadjuvant chemotherapy, EPO can significantly increase Hb levels in cancer patients during chemotherapy.
A single-center, prospective, non-randomized phase II clinical study explored the effect of EPO on 24 patients with neoadjuvant chemotherapy for esophageal and gastric adenocarcinoma.
Results It showed that the Hb level increased from 11.
5 g/dL to 12.
6 g/dL after EPO treatment, and EPO treatment was effective and well tolerated
.
In addition, Professor Zhou Guoren emphasized that correcting anemia before neoadjuvant chemotherapy can improve the anti-tumor response and prognosis, and improve the effect of tumor treatment
.
In the perioperative period, EPO can effectively reduce the number of blood transfusions for cancer patients.
The results of a double-blind placebo-controlled study of gastrointestinal cancer patients showed that the intraoperative blood transfusion rate of patients in the EPO treatment group and the placebo group was 29.
0% and 29.
0%, respectively.
The postoperative blood transfusion rate was 3.
2% and 28.
0%, respectively.
After receiving EPO treatment, the number of intraoperative and postoperative blood transfusions was significantly reduced.
Compared with the placebo group, the postoperative hematocrit, hemoglobin and hemoglobin of the EPO treatment group The reticulocyte count increased significantly
.
In addition, related studies have shown that the use of EPO before surgery is more conducive to the recovery of patients
.
During radiotherapy and chemotherapy, the use of EPO can enable patients to obtain higher Hb levels, longer survival time, and higher disease control rates
.
A prospective, randomized, controlled, and open study in Germany enrolled 385 inoperable stage III NSCLC patients, who were randomly divided into sequential radiotherapy and chemotherapy (RCHT) groups and RCHT+EPO groups.
The results showed that patients in the RCHT+EPO group The Hb level of RCHT+EPO group was significantly increased, and the 2-year survival rate of patients in the RCHT+EPO group was 28.
5%, which was higher than 20.
6% in the RCHT group.
The median survival time of patients in the RCHT+EPO group and RCHT group were 524 days and 454 days, respectively
.
In addition, the results of an open phase II study of patients with gastric cancer/esophageal gastric junction cancer showed that the PFS of patients with and without EPO were 5.
3 months and 3.
9 months, and the OS was 14.
5 months and 8.
0, respectively.
Month, the disease control rate (DCR) was 78% and 55%, respectively
.
A meta-analysis of 27 randomized controlled trials showed that compared with standard treatment, patients treated with EPO had a 33% reduction in blood transfusion requirements; compared with standard treatment, patients treated with EPO had a 19% reduction in the risk of death
.
In addition, studies have shown that EPO can also significantly improve the quality of life of CRA patients
.
During palliative care, Hb level is an independent risk factor that affects the survival time of patients receiving palliative care.
It is worth noting that the incidence of anemia in patients with end-stage malignant tumors is significantly increased, and EPO can significantly increase the cumulative survival rate of palliative care patients
.
EPO should be used in a standardized manner.
For anemia caused by tumor chemotherapy, the starting dose of EPO is 150 IU/kg/time, subcutaneously injected three times a week; or 36000 IU/time, once a week, subcutaneously injected
.
If after 8 weeks of treatment, the need for blood transfusion cannot be effectively reduced or the hematocrit cannot be increased, the dose can be increased to 200 IU/kg/time, subcutaneously injected three times a week
.
During the perioperative period, red blood cell mobilization is suitable for elective surgical patients whose preoperative hemoglobin value is 100-130 g/L (except for cardiovascular surgery).
The dosage of EPO is 150 IU/kg/time, 3 times a week.
Subcutaneous injection, used 10 days before surgery to 4 days after surgery, can reduce intraoperative and postoperative anemia, reduce the need for allogeneic blood transfusion, and accelerate the recovery of postoperative anemia tendency
.
To prevent iron deficiency during medication, iron supplements can be added at the same time
.
Summary Professor Zhou Guoren concluded: CRA is one of the common concomitant diseases of malignant tumors.
Anemia has a negative impact on the anti-tumor treatment effect, OS and quality of life of tumor patients; CRA's full management covers different tumor treatment stages and is used in a standardized manner.
EPO helps correct anemia in patients, improve treatment effects, prolong survival and improve quality of life
.
Professor Zhou Guoren, Chief Physician, and Postdoctoral Cooperative Supervisor, Deputy Dean of Jiangsu Cancer Hospital, Doctor of Medicine, Master Supervisor of Nanjing Medical University, Master Supervisor of Nanjing Normal University, Master Supervisor of Nanjing Normal University, Master Supervisor of Jiangsu Province "Six Talent Peaks" High-level talent training target Jiangsu Province "333 Project" "Talent training target National Standing Committee Member of the Molecular Tumor and Immunotherapy Professional Committee of the Chinese Research Hospital Association Member of the Standing Committee of the Abdominal Tumor Committee of the Chinese Medical Education Association Member of the Chinese Physician Association Chinese and Western Medicine Oncology Branch Standing Committee Member of the Jiangsu Provincial Medical Association of Elderly Member of the Medical Branch Member of the Hepatobiliary and Pancreatology Group of the Oncology Branch of the Jiangsu Medical Association Group members presided over 5 provincial and departmental-level projects; published more than 20 SCI academic papers and won the third prize of Jiangsu Provincial Government Science and Technology Award, and the second prize of New Technology Introduction Award stamped "read the original text", we make progress together
At this conference, Professor Zhou Guoren from Jiangsu Cancer Hospital conducted the "Hazards and Full Management of Tumor-related Anemia" In the theme report, Yimaitong organizes the main content as follows
.
Cancer-associated anemia (CRA) mainly refers to the anemia that occurs in tumor patients during the development of their disease and during treatment.
It is one of the common accompanying diseases of malignant tumors.
About 30%-90% of tumor patients will develop anemia.
.
Professor Zhou Guoren introduced the harm of CRA and the optimal management of erythropoietin (EPO)-CRA in two aspects
.
The harm of CRA Professor Zhou Guoren said that the related factors that cause CRA include insufficient nutritional intake, relatively insufficient EPO production, iron metabolism disorders, and various treatment methods (chemotherapy, radiotherapy, surgical treatment, etc.
)
.
It should be noted that targeted therapy and immunotherapy can also cause CRA.
In large clinical trials, grade 1-4 anemias of targeted therapy drugs PARP inhibitors olaparib, lukapanib and niraparib occurred The rates are 90%, 37% and 50% respectively
.
The CheckMate 078 study showed that the incidence of anemia caused by nivolumab is approximately 4%
.
The results of the Phase I study of Karelizumab showed that the incidence of anemia was 11%, of which grades 3-4 accounted for 2%
.
CRA is more harmful and has a negative impact on the anti-tumor effect, overall survival (OS) and quality of life of patients
.
CRA can aggravate tumor hypoxia, leading to radioresistance and chemotherapy drug resistance.
A study involving 140 patients with non-small cell lung cancer (NSCLC) receiving chemotherapy showed that anemia before and during chemotherapy significantly reduced patients’ anti-tumor resistance The treatment effect shows that anemia reduces the sensitivity of chemotherapy and affects the effect of chemotherapy
.
In an EOX regimen (epirubicin, oxaliplatin, and capecitabine) in the treatment of 58 patients with advanced gastric cancer, as well as an evaluation of hemoglobin (Hb) changes and anemia and survival during baseline and concurrent radiotherapy and chemotherapy Studies on the relationship and its impact on the prognosis of NSCLC patients have shown that anemia significantly shortens the median progression-free survival (PFS) and median OS of tumor patients
.
Professor Zhou Guoren also emphasized that anemia is an independent factor influencing the poor prognosis of gastric cancer.
Correcting anemia is expected to improve the prognosis
.
In addition, anemia can also reduce the quality of life of patients.
A prospective study involving 218 cancer patients (64% of patients with anemia) showed that patients with anemia had significantly lower quality of life scores than normal patients (135 vs 150)
.
Therefore, Professor Zhou Guoren said here that correcting anemia is expected to improve the treatment effect and prognosis of cancer patients
.
The preferred treatment for EPO-CRA throughout the management of CRA The most commonly used and most studied erythropoiesis stimulant (ESA) is EPO
.
EPO can be used for the treatment of anemia in different tumor treatment stages (including neoadjuvant chemotherapy [+radiotherapy], perioperative period, postoperative chemotherapy [+radiotherapy], palliative treatment)
.
Professor Zhou Guoren said that how to standardize the use of EPO is an important skill that clinicians need to master
.
During neoadjuvant chemotherapy, EPO can significantly increase Hb levels in cancer patients during chemotherapy.
A single-center, prospective, non-randomized phase II clinical study explored the effect of EPO on 24 patients with neoadjuvant chemotherapy for esophageal and gastric adenocarcinoma.
Results It showed that the Hb level increased from 11.
5 g/dL to 12.
6 g/dL after EPO treatment, and EPO treatment was effective and well tolerated
.
In addition, Professor Zhou Guoren emphasized that correcting anemia before neoadjuvant chemotherapy can improve the anti-tumor response and prognosis, and improve the effect of tumor treatment
.
In the perioperative period, EPO can effectively reduce the number of blood transfusions for cancer patients.
The results of a double-blind placebo-controlled study of gastrointestinal cancer patients showed that the intraoperative blood transfusion rate of patients in the EPO treatment group and the placebo group was 29.
0% and 29.
0%, respectively.
The postoperative blood transfusion rate was 3.
2% and 28.
0%, respectively.
After receiving EPO treatment, the number of intraoperative and postoperative blood transfusions was significantly reduced.
Compared with the placebo group, the postoperative hematocrit, hemoglobin and hemoglobin of the EPO treatment group The reticulocyte count increased significantly
.
In addition, related studies have shown that the use of EPO before surgery is more conducive to the recovery of patients
.
During radiotherapy and chemotherapy, the use of EPO can enable patients to obtain higher Hb levels, longer survival time, and higher disease control rates
.
A prospective, randomized, controlled, and open study in Germany enrolled 385 inoperable stage III NSCLC patients, who were randomly divided into sequential radiotherapy and chemotherapy (RCHT) groups and RCHT+EPO groups.
The results showed that patients in the RCHT+EPO group The Hb level of RCHT+EPO group was significantly increased, and the 2-year survival rate of patients in the RCHT+EPO group was 28.
5%, which was higher than 20.
6% in the RCHT group.
The median survival time of patients in the RCHT+EPO group and RCHT group were 524 days and 454 days, respectively
.
In addition, the results of an open phase II study of patients with gastric cancer/esophageal gastric junction cancer showed that the PFS of patients with and without EPO were 5.
3 months and 3.
9 months, and the OS was 14.
5 months and 8.
0, respectively.
Month, the disease control rate (DCR) was 78% and 55%, respectively
.
A meta-analysis of 27 randomized controlled trials showed that compared with standard treatment, patients treated with EPO had a 33% reduction in blood transfusion requirements; compared with standard treatment, patients treated with EPO had a 19% reduction in the risk of death
.
In addition, studies have shown that EPO can also significantly improve the quality of life of CRA patients
.
During palliative care, Hb level is an independent risk factor that affects the survival time of patients receiving palliative care.
It is worth noting that the incidence of anemia in patients with end-stage malignant tumors is significantly increased, and EPO can significantly increase the cumulative survival rate of palliative care patients
.
EPO should be used in a standardized manner.
For anemia caused by tumor chemotherapy, the starting dose of EPO is 150 IU/kg/time, subcutaneously injected three times a week; or 36000 IU/time, once a week, subcutaneously injected
.
If after 8 weeks of treatment, the need for blood transfusion cannot be effectively reduced or the hematocrit cannot be increased, the dose can be increased to 200 IU/kg/time, subcutaneously injected three times a week
.
During the perioperative period, red blood cell mobilization is suitable for elective surgical patients whose preoperative hemoglobin value is 100-130 g/L (except for cardiovascular surgery).
The dosage of EPO is 150 IU/kg/time, 3 times a week.
Subcutaneous injection, used 10 days before surgery to 4 days after surgery, can reduce intraoperative and postoperative anemia, reduce the need for allogeneic blood transfusion, and accelerate the recovery of postoperative anemia tendency
.
To prevent iron deficiency during medication, iron supplements can be added at the same time
.
Summary Professor Zhou Guoren concluded: CRA is one of the common concomitant diseases of malignant tumors.
Anemia has a negative impact on the anti-tumor treatment effect, OS and quality of life of tumor patients; CRA's full management covers different tumor treatment stages and is used in a standardized manner.
EPO helps correct anemia in patients, improve treatment effects, prolong survival and improve quality of life
.
Professor Zhou Guoren, Chief Physician, and Postdoctoral Cooperative Supervisor, Deputy Dean of Jiangsu Cancer Hospital, Doctor of Medicine, Master Supervisor of Nanjing Medical University, Master Supervisor of Nanjing Normal University, Master Supervisor of Nanjing Normal University, Master Supervisor of Jiangsu Province "Six Talent Peaks" High-level talent training target Jiangsu Province "333 Project" "Talent training target National Standing Committee Member of the Molecular Tumor and Immunotherapy Professional Committee of the Chinese Research Hospital Association Member of the Standing Committee of the Abdominal Tumor Committee of the Chinese Medical Education Association Member of the Chinese Physician Association Chinese and Western Medicine Oncology Branch Standing Committee Member of the Jiangsu Provincial Medical Association of Elderly Member of the Medical Branch Member of the Hepatobiliary and Pancreatology Group of the Oncology Branch of the Jiangsu Medical Association Group members presided over 5 provincial and departmental-level projects; published more than 20 SCI academic papers and won the third prize of Jiangsu Provincial Government Science and Technology Award, and the second prize of New Technology Introduction Award stamped "read the original text", we make progress together
