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DOI: 10.1055/s-2005-870848
© Georg Thieme Verlag Stuttgart · New York
Einfluss des Hämoglobinwertes auf Prognose und Lebensqualität beim Bronchialkarzinom
The effect of haemoglobin levels on prognosis and quality of life of patients with bronchial carcinomaPublication History
eingereicht: 6.12.2004
akzeptiert: 28.4.2005
Publication Date:
08 June 2005 (online)

Zusammenfassung
Aufgrund tumor- und therapieassoziierter Ursachen, ist die Anämie bei Patienten mit Bronchialkarzinom besonders häufig. Die hierdurch bedingten Symptome wie Dyspnoe, Müdigkeit, Abgeschlagenheit und reduzierter Allgemeinzustand schränken die Lebensqualität ein und können die konsequente Durchführung einer zytostatischen Therapie erschweren oder gar verhindern. Der Therapieerfolg einer sauerstoffabhängigen antitumoraler Therapie, wie etwa der Strahlentherapie und auch verschiedener Zytostatika, kann durch Hypoxie im Tumorgewebe vermindert oder gefährdet sein.
Zur Anämiekorrektur kann neben Bluttransfusionen auch rekombinantes humanes Erythropoietin verwendet werden. Erythropoietine sind gut verträglich und ermöglichen einen langanhaltenden, gleichmäßigen Anstieg des Hb-Wertes, wie er durch Transfusionen nicht erreicht werden kann. Transfusionsrisiken wie Unverträglichkeitsreaktionen oder die Übertragung von Infektionen können hierdurch vermieden werden.
In den verschiedenen hier vorgestellten Studien wurde in den letzten Jahren der Einfluss einer Anämiekorrektur mit Erythropoietinen auf den Transfusionsbedarf und die Lebensqualität von Patienten mit Bronchialkarzinomen untersucht. Sie kommen übereinstimmend zu dem Ergebnis, dass sich beide Parameter durch eine Erythropoietin-Therapie verbessern lassen. Hierbei zeigte sich, dass sich die Lebensqualität bei Erreichen eines Hb-Wertes von etwa 12 g/dl am stärksten verbesserte.
Studien zum Einfluss einer Anämiekorrektur auf die Prognose der Patienten zeigen in der Mehrzahl ebenfalls positive Effekte. Um zur endgültigen Klärung diese Punktes beizutragen, hat unsere Heidelberger Arbeitsgruppe eine prospektive randomisierte Phase-III-Studie bei NSCLC-Patienten aufgelegt, die in diesem Rahmen ebenfalls erläutert wird.
Summary
As a consequence of tumour and therapy related effects anaemia is a particularly frequent occurrence in patients with lung cancer. The ensuing symptoms such as dyspnoea, fatigue and decreased general health reduce their quality of life and can impede if not altogether prevent an effective cytostatic therapy. A positive outcome after oxygen-dependent anti-tumour therapy, for example radiation therapy or various cytostatic treatments as well, can be reduced or even put at risk when tumour tissue is hypoxic.
In order to treat anaemia, recombinant human erythropoietin can be used beside blood transfusions. Erythropoietins are well tolerated and allow for a long-lasting, gradual increase of Hb-levels, which cannot be achieved via transfusions. Furthermore, transfusion risks such as intolerance reactions or disease transmission can also be avoided.
The various studies presented here evaluated the impact of anaemia treatment with erythropoietins on the need for transfusions and quality of life of patients with lung cancer over the last few years. They all agreed in their conclusion that both parameters can be improved with erythropoietin therapy. It turned out that the patients‘ quality of life improved most when Hb levels reached around 12 g/dl .
Studies examining the impact of anaemia treatment on a patient’s prognosis also showed positive effects in the majority of cases. In order to investigate this issue, our Heidelberg work group has designed a prospective, randomised phase-III study on NSCLC patients, which will be explained in detail further down.
Literatur
- 1
Becker A, Stadler P, Lavey R S. et al .
Severe anemia is associated with poor tumor oxygenation in head and neck squamos cell
carcinomas.
Int J Radial Oncol Biol Phys.
2000;
46
459-466
MissingFormLabel
- 2
Blohmer J U, Wurschmidt F, Petry U. et al .
Results with sequential adjuvant chemo-radiotherapy with vs without epoetin alfa for
patients with high-risk cervical cancer: Results of a prospective, randomized, open
and controlled AGO- and NOGGO-intergroup study.
Ann Oncol, Volume.
2004;
15
(Suppl 3)
128
MissingFormLabel
- 3 Bohlius J, Langensiepen S, Schwarzer G. et al .Erythropoietin for patients with malignant disease. The Cochrane Database of Systematic
Reviews. Issue 3. Art. No.: CD003407.pub2. DOI: 10.1002/14 651 858.CD003407.pub2 2004
MissingFormLabel
- 4
Bohlius J, Langensiepen S, Schwarzer G. et al .
Recombinant Human Erythropoietin and Overall Survival in Cancer Patients: Results
of a Comprehensive Meta-analysis.
J Natl Cancer Inst.
2005;
97
489-498
MissingFormLabel
- 5
Bokemeyer C, Aapro M S, Courdi A. et al .
EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer.
European Journal of Cancer.
2004;
40
2201-2216
MissingFormLabel
- 6
Casas F, Vinolas N, Ferrer F. et al .
Improvement in performance status after erythropoietin treatment in lung cancer patients
undergoing concurrent chemoradiotherapy.
Int J Radiation Biol Phys.
2003;
55
116-124
MissingFormLabel
- 7
Casadevall N, Natar J, Viron B. et al .
Pure red-cell aplasia and antierythropoietin antibodies in patients treated with recombinant
erythropoietin.
N Engl J Med.
2002;
346
469-475
MissingFormLabel
- 8
Crawford J, Cella D, Cleeland C S. et al .
Relationship between changes in hemoglobin level and quality of life during chemotherapy
in anemic cancer patients receiving epoetin alfa therapy.
Cancer.
2002;
95
888-895
MissingFormLabel
- 9
Crawford J, Demetri G D, Gabrilove J L. et al .
Clinical benefit of epoetin alfa therapy in patients with lung cancer.
Clinical Lung cancer.
2002;
3
180-190
MissingFormLabel
- 10
Curran W J, Scott C, Langer . et al .
Phase III comparison of sequential vs. concurrent chemoradiation for patients with
unresected stage III non-small lung cancer (NSCLC): initial report of Radiation Therapy
Oncology Group (RTOG) 9410 (Abstract 303).
Lung Cancer.
2000;
29
93
MissingFormLabel
- 11
Dalton J, Bailey N, Barret-Lee P. et al .
Multicenter UK audit of anemia in patients receiving cytotoxic chemotherapy (Abstract
# 1611).
Proc Am Soc Clin Oncol.
1998;
17
418
MissingFormLabel
- 12
Demetri G D, Kris M, Wade J. et al .
Quality-of-life benefit in chemotherapy patients treated with Epoetin alfa is independent
of disease response or tumor type: Results from a prospective community oncology study.
J Clin Oncol.
1998;
16
3412-3425
MissingFormLabel
- 13
Gabrilove J L, Cleeland C S, Livingston R B. et al .
Clinical evaluation of once-weekly dosing of epoetin alfa in chemotherapy patients:
improvements in hemoglobin and quality of life are similar to three-times-weekly dosing.
J Clin Oncol.
2001;
19
2875-2882
MissingFormLabel
- 14
Glaser C M, Millesi W, Kornek G V. et al .
Impact of hemoglobin level and use of recombinant erythropoietin on efficacy of preoperative
chemoradiation therapy for squamos cell carcinoma of the oral cavity and oropharynx.
Int J Radiat Oncol Biol Phys.
2001;
50
705-715
MissingFormLabel
- 15
Glaspy J, Bukowsky R, Steinberg D. et al .
Impact of therapy with Epoetin alfa on clinical outcomes in patients with nonmyeloid
malignancies during cancer chemotherapy in community oncology practice.
J Clin Oncol.
1997;
15
1218-1234
MissingFormLabel
- 16
Heiss M M, Delanoff C.
Immunmodulatorische Wirkung der Bluttransfusion und Einfluss auf Infektionsrate und
Tumorrezidiv.
Infusionsther Transfusionsmed.
1997;
24
20-31
MissingFormLabel
- 17
Henke M, Laszig R, Rübe C. et al .
Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy:
randomised double-blind, placebo-controlled trial.
The Lancet.
2003;
362
1255-1260
MissingFormLabel
- 18
Höckel M, Schlenger K, Aral B. et al .
Association between tumor hypoxia and malignant progression in advanced cancer of
the uterine cervix.
Cancer Res.
1996;
56
4509-4515
MissingFormLabel
- 19
Höckel M, Vaupel P.
Tumor hypoxia: definitions and current clinical, biological, and molecular aspects.
J Natl Cancer Inst.
2001;
93
266-267
MissingFormLabel
- 20
Langer C, Barsevick A, Brunner D. et al .
Correlation of quality of life (QOL) with survival, treatment response and anemia
in patients with advanced non-small cell lung cancer (NSCLC) treated with carboplatin
and paclitaxel (Abstract #79).
Lung Cancer.
1997;
18
(Suppl 1)
23
MissingFormLabel
- 21
Leyland-Jones B.
Reflection and reaction.
The Lancet Oncology.
2003;
4
459-456
MissingFormLabel
- 22
Littlewood T J, Bajetta E, Nortier J W. et al .
Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients
receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled
trial.
J Clin Oncol.
2001;
19
2865-2874
MissingFormLabel
- 23
Ludwig H, Fritz E, Leitgeb C. et al .
Prediction of response to erythropoietin treatment in chronic anemia of cancer.
Blood.
1994;
84
1056-1063
MissingFormLabel
- 24
MacRae R, Shyr Y, Johnson D. et al .
Declining hemoglobin during chemoradiotherapy for locally advanced non-small cell
lung cancer is significant.
Radiother Oncol.
2002;
64
37-40
MissingFormLabel
- 25
Miller C B, Jones R J, Plantadosi S. et al .
Decreased erythropoietin response in patients with the anemia of cancer.
N Eng J Med.
1990;
322
1689-1692
MissingFormLabel
- 26 Möbus V J, Untch M, Du Bois A. et al .Dose-dense sequential chemotherapy with epiribicin (E), paclitaxel (T) and cyclophosphamide
(C) (ETC) is superior to conventional dosed chemotherapy in high-risk breast cancer
patients. Oral presentation at ASCO abstract No. 513 2004
MissingFormLabel
- 27 Nowrousian M R, Kasper C, Oberhoff C. et al .rh-Erythropoietin in cancer supportive treatment. New York: Marcel Dekker 1996: 13-34
MissingFormLabel
- 28
Ohlhauser C, Bülzebruck H, Ebert W. et al .
Prognostic factors for survival in inoperable non-small-cell lung cancer: a multivariate
regression analysis of 456 patients with radiation therapy.
Onkologie.
1997;
20
126-131
MissingFormLabel
- 29
Rizzo J D, Lichtin A E, Woolf S H. et al .
Use of Epoetin in Patients With Cancer: Evidence-Based Clinical Practice Guidelines
of the American Society of Clinical Oncology and the American Society of Hematology.
J Clin Onc.
2002;
20
4083-4107
MissingFormLabel
- 30
Sasai K, Ono K, Hiraoka M. et al .
The effect of arterial oxygen content on the results of radiation therapy for epidermoid
bronchogenic carcinoma.
Int J Rad Oncol Biol Phys.
1989;
16
1477-1481
MissingFormLabel
- 31
Takigawa N, Segawa Y, Okahara M. et al .
Prognostic factors for patients with advanced non-small cell lung cancer: univariate
and multivariate analyses including recursive partitioning and amalgamation.
Lung Cancer.
1996;
15
67-77
MissingFormLabel
- 32
Thatcher N.
Management of chemotherapy-induced anemia in solid tumors.
Semin Oncol.
1998;
25
23-26
MissingFormLabel
- 33
Vansteenkiste J, Pirker R, Massuti B. et al .
Double-blind, placebo-controlled, randomized phase III trial of darbepoetin alfa in
lung cancer patients receiving chemotherapy.
J Natl Cancer Inst.
2002;
94
1211-1220
MissingFormLabel
- 34 Vaupel P, Höckel M. Tumor hypoxia and therapeutic resistance. Springer Wien New York In: Nowrousian MR (Ed.) Recombinant human erythropoietin (rhEPO) in clinical oncology.
Scientific and clinical aspects of anemia in cancer 2002: 128-146
MissingFormLabel
- 35
Vaupel P, Mayer A.
Erythropoietin to treat anemia in patients with head and neck cancer.
The Lancet.
2004;
363
992
MissingFormLabel
- 36
Vogelzang N, Breitbart W, Cella D. et al .
Patient, caregiver and oncologist perceptions of cancer-related fatigue: results of
a tripart assessment survey.
Semin Hematol.
1997;
34
4-12
MissingFormLabel
- 37
Wilhelm R, Kovac G, Heinrichsohn R. et al .
Überlebenszeiten ausschließlich bestrahlter NSCLC-Patienten.
Strahlentherapie und Onkologie.
1998;
174
128-132
MissingFormLabel
- 38
Wu H S, Little A G.
Perioperative blood transfusions and cancer recurrence.
J Clin Oncol.
1998;
6
1348-1354
MissingFormLabel
Prof. Dr. med. P. Drings
Thoraxklinik-Heidelberg gGmbH
Amalienstraße 5
69126 Heidelberg
Phone: 06221/396257
Fax: 06221/396541
Email: peter.drings@thoraxklinik-heidelberg.de