The impact of erythropoiesis-stimulating agent therapy on survival outcomes in patients with anemia associated with metastatic malignancies (а systematic review and meta-analysis)

Introduction. Erythropoiesis-stimulating agents (ESAs) hold the key place in the treatment of anemia in patients with cancer. Their clinical effectiveness is confirmed by the results of numerous studies, including meta-analyses. However, the impact of ESA on overall survival and progression-free survival remains a matter of debate due to the heterogeneity of results and differences in clinical trial design. In this regard, we conducted a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of ESA in cancer patients with anemia.

Aim. To evaluate the effect of ESA on overall survival, progression-free survival, objective response rate, and incidence of venous thromboembolic events in anemic patients receiving anticancer therapy for malignancies with metastasis.

Materials and methods. A systematic review and meta-analysis of results of controlled randomized clinical trials conducted during 2012–2025 and evaluating effect of EPA on the survival of patients with malignancies with metastatic involvement and anemia have been performed. In 6 databases, 529 publications on this topic were found. The analysis included 4 randomized clinical trials involving 5,117 patients 18 years and older with cancer and anemia. The effects of ESA on overall survival, progression-free survival, objective response rate, and incidence of venous thromboembolic events were evaluated.

Results. There was no statistically significant differences between patients from groups with ESA therapy and control groups (placebo, red blood cell transfusion, or no treatment) (n = 2,957 vs n = 2,145; hazard ratio (HR) 0.98; 95 % confidence interval (CI) 0.90–1.05), progression-free survival (n = 2713 vs n = 1937; HR 1.00; 95 % CI 0.91–1.11), objective response rate (n = 1,440 vs n = 1,428; HR 1.12; 95 % CI 0.18–7.12) and incidence of venous thromboembolic events (n = 2,915 vs n = 2,071; HR 1.67; 95 % CI 0.81–3.45).

Conclusion. In the analyzed population of patients with malignancies and anemia, ESA therapy does not worsen overall survival, progression-free survival, objective response rate, and does not increase the risk of venous thromboembolic events.

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