In Reply to ‘Erythropoietin and Cancer: An Old Risk’

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We thank Drs Buemi, Campo, and Bolignano for their comments.¹ We agree that research has suggested a variety of mechanisms for the adverse outcomes seen in patients with malignancies treated with erythropoietin-stimulating agents (ESAs); there is little doubt that these adverse effects are caused by effects remote from the activity of ESAs on bone marrow. As discussed by Buemi et al,¹ these effects likely are mediated in part by specific cell-surface receptors and intracellular effectors for ESAs.

Using ESAs for the treatment of patients with cancer-associated anemia should be undertaken only in compliance with the appropriate labeled indications for each individual product. Routine use in patients with cancer-associated anemia cannot be recommended and should not be endorsed because it may result in otherwise avoidable adverse outcomes, including death.

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Financial Disclosure: None.

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Reference 

1. Buemi M, Campo S, Bolignano D. Erythropoietin and cancer: An old risk. Am J Kidney Dis. 2009;53:1102;(ltr)
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