Erythropoiesis-Stimulating Agents and the Practice of Gynecologic Oncology

Patients with gynecologic cancers, especially epithelial ovarian cancer, are frequently anemic during chemotherapy. Therapy with recombinant erythropoietic proteins is associated with an increase in hemoglobin concentration and a reduction in transfusion requirements during chemotherapy. Over the past several years, it has become clear that erythropoietic therapy is associated with an increased incidence of venous thrombosis, especially during pelvic radiation therapy. Moreover, recent data largely obtained in patients with non-gynecologic cancer have raised a concern that erythropoietic therapy might in some way enhance tumor progression or decrease survival of patients with cancer. The preclinical and clinical data are reviewed herein. For patients with ovarian cancer, treatment with erythropoietic proteins has not been associated with adverse tumor outcomes, although the data are limited, and additional trials are needed.