贫血是癌症的常见并发症。癌症贫血的治疗至关重要,因为贫血会对生活质量产生不利影响,治疗结果,和总体生存率。促红细胞生成刺激剂(ESAs)是治疗癌症相关性贫血的有价值的药物。心血管不良反应是ESA治疗的一个重要问题,并且接受ESA治疗的患者的治疗目标和特征存在很大差异。因此,有必要仔细分析有关这些药物疗效和安全性的现有数据.此数据分析将有助于合理使用ESAs治疗癌症贫血。本系统综述的目的是阐明癌症贫血的发病机制。评估ESAs治疗癌症贫血的有效性,以及与使用ESAs相关的心血管不良反应的总体风险及其对预后的影响。我们从在线数据库中搜索文献-PubMed,PubMedCentral,MEDLINE,科克伦图书馆,和临床试验注册(clinicaltrials.gov),以确定前瞻性II期和III期随机对照试验(RCTs)。我们选择了直接比较接受ESA治疗的癌症患者与未接受ESA治疗的患者的RCT。日期下限为2008年1月,上限为2021年5月。仅包括英语语言文学和人类研究。使用Cochrane风险偏差评估工具完成了质量评估,我们在17个RCTs中确定了10,738例癌症患者的数据,并纳入系统评价.我们的评论得出结论,ESA有效地降低了贫血癌症患者输血的必要性并增加了平均血红蛋白水平。ESA治疗与心血管不良反应有关,包括静脉血栓栓塞,血栓性静脉炎,高血压,缺血性心脏病,心力衰竭,心律失常,动脉血栓栓塞,还有心脏骤停.积极的ESA剂量以达到更高的血红蛋白水平和预先存在的不受控制的高血压增加了这些心血管副作用。静脉血栓栓塞是归因于ESA治疗的最显著的不良反应。然而,ESA治疗的总生存率没有重大变化,ESAs的给药可以在贫血的癌症患者中进行,并仔细评估血栓栓塞的危险因素,风险收益比,和监测血红蛋白水平。
Anemia is a common complication of cancer. Treatment of anemia in cancer is crucial as anemia adversely affects the quality of life, therapeutic outcomes, and overall survival. Erythropoiesis stimulating agents (ESAs) are valuable drugs for treating cancer-related anemia. Cardiovascular adverse effects are a significant concern with ESA therapy, and there is wide variability in therapeutic goals and characteristics of patients who undergo treatment with ESAs. As a result, a careful analysis of the currently available data on the efficacy and safety of these drugs is necessary. This data analysis will aid in the rational use of ESAs for the treatment of anemia in cancer. The objective of this systematic review is to elucidate the pathogenesis of anemia in cancer, assess the effectiveness of ESAs in treating anemia in cancer, and the overall risk of cardiovascular adverse effects associated with the use of ESAs and their impact on prognosis. We searched literature from online databases - PubMed, PubMed Central, MEDLINE, Cochrane Library, and clinical trials register (clinicaltrials.gov) to identify prospective phase II and phase III randomized controlled trials (RCTs). We chose RCTs that directly compared patients with cancer who were treated with ESAs to those who were not treated with ESAs. January 2008 was taken as the lower date limit and May 2021 as the upper date limit. Only English language literature and human studies were included. The quality appraisal was completed using the Cochrane risk bias assessment tool, and data from a total of 10,738 patients with cancer in 17 RCTs were identified and included for systematic review. Our review concludes that ESAs effectively reduce the necessity for blood transfusions and increase mean hemoglobin levels in anemic cancer patients. ESA therapy is associated with cardiovascular adverse effects, including venous thromboembolism, thrombophlebitis, hypertension, ischemic heart disease, cardiac failure, arrhythmia, arterial thromboembolism, and cardiac arrest. Aggressive ESA dosing to achieve higher hemoglobin levels and preexisting uncontrolled hypertension increases these cardiovascular side effects. Venous thromboembolism is the most significant adverse effect attributed to ESA therapy. However, there is no major change in overall survival with ESA therapy, and administration of ESAs can be carried out in anemic cancer patients with careful assessment of thromboembolism risk factors, risk-benefit ratio, and monitoring of hemoglobin levels.