RESUMO
The use of recombinant human erythropoietin (r-HuEPO) in cancer patients improves hemoglobin levels and quality of life. This fact, already well known, made oncologists expect a positive outcome in radio and chemotherapy results, as well as in survival. However, new clinical trials show a preliminary evidence of impaired, instead of improved, survival when these agents are prescribed. Erythropoietin (EPO) is becoming a more complex hormone than it was expected. Its non-erythropoietic effects include, among others, angiogenesis and proliferation of certain types of cancer cells. In this work, we review erythropoietin as a natural hormone, as well as the different types of r-HuEPO, focusing on the confusing situation with regard to their use in oncology. We conclude that extreme care must be taken when EPO is prescribed to cancer patients, and we suggest to limit its use to symptomatic anemia, just to achieve moderate hemoglobin levels.
Assuntos
Anemia/etiologia , Eritropoetina/fisiologia , Eritropoetina/uso terapêutico , Neoplasias/sangue , Anemia/tratamento farmacológico , Hemoglobinas/metabolismo , Humanos , Neoplasias/complicações , Neoplasias/terapia , Proteínas RecombinantesRESUMO
La utilización de eritropoyetinas recombinantes humanas en pacientes con cáncer mejora la anemia y la calidad de vida. Este hecho ya demostrado hacía presagiar una repercusión positiva en los resultados de la radioterapia y la quimioterapia y en el pronóstico oncológico global. Estudios clínicos recientes parecen indicar, todavía de modo provisional, un detrimento en lugar de mejora en la supervivencia cuando se administran estos fármacos. La eritropoyetina aparece cada vez más nítidamente como una hormona mucho más compleja de lo que suponíamos. Sus efectos no eritropoyéticos incluyen, entre muchos otros, estimulación de la angiogénesis y de la proliferación celular de diversas líneas tumorales. Revisamos la eritropoyetina como hormona natural y las diversas eritropoyetinas recombinantes humanas existentes, deteniéndonos en el confuso panorama actual de su utilización en oncología. Concluimos que debe extremarse la cautela cuando se utilice en pacientes con cáncer y proponemos limitar su uso a anemias sintomáticas y, en todo caso, establecer como objetivo valores de hemoglobina muy moderados
The use of recombinant human erythropoietin (r-HuEPO) in cáncer patients improves hemoglobin levels and quality of life. This fact, already well known, made oncologists expect a positive outcome inradio and chemotherapy results, as well as in survival. However, new clinical trials show a preliminary evidence of impaired, instead of improved, survival when these agents are prescribed. Erythropoietin(EPO) is becoming a more complex hormone than it was expected. Itsnon-erythropoietic effects include, among others, angiogenesis andproliferation of certain types of cancer cells. In this work, we review erythropoietin as a natural hormone, as well as the different types of r-HuEPO, focusing on the confusing situation with regard to their use in oncology. We conclude that extreme care must be taken when EPO is prescribed to cancer patients, and we suggest to limit its use to symptomatic anemia, just to achieve moderate hemoglobin levels
