Treatment strategy optimization for patients with non-small-cell lung cancer harboring EGFR mutation: a Delphi consensus

Aim To stablish a consensus on the treatment strategy for advanced non–small-cell lung cancer (aNSCLC) with epidermal growth factor receptor mutation (EGFRm) in Spain. Methods After a systematic literature review, the scientific committee developed 33 statements in 4 fields: molecular diagnosis (10 items); histologic profile and patient clinical characteristics (7 items); first-line (1L) treatment in EGFRm aNSCLC (8 items); and subsequent-line treatment (8 items). A panel of 31 experts completed 2 Delphi online questionnaires rating their degree of agreement/disagreement for each statement through a 1–9 range scale (1–3 = disagree, 7–9 = agree). Consensus was reached if 2/3 of the participants are in the median range. Results In the first Delphi round consensus was achieved for 24/33 of the statements. One of the assertions was deleted, proceeding to a second round with the eight remaining questions with no consensus or in the range of indeterminacy. Determination of the EGFR status from tissue and analysis of the different biomarkers are two important variables that influenced treatment decision in patients with aNSCLC. 1L treatment should be the best therapeutic option, independently of the subsequent lines of treatment. For patients with the most common activating mutations osimertinib was considered the most efficient and safe 1L option. In case of disease progression, a new biopsy was needed. Conclusions A consensus document is proposed to optimize the treatment strategy for untreated patients with a NSCLC with EGFR sensitizing mutations (AU)

Efficacy of tyrosine kinase inhibitors in EGFR-mutant lung cancer women in a real-world setting: the WORLD07 database

Background. The WORLD07 project is a female specific database to assess the characteristics of women with lung cancer. Methods. WORLD07 database sets up in 2007, and prospectively stores clinical characteristics, treatment, outcome, and follow-up of lung cancer women. All women with epidermal growth factor receptor (EGFR) mutation non-small cell lung cancer (NSCLC) were selected for this analysis. Results. From October 2007 to December 2012, a total of 1775 NSCLC women were recruited. EGFR mutation was identified in 34.4% of patients. Upfront EGFR tyrosine kinase inhibitor (TKI) reported a response rate of 60%, a median progression-free survival of 11.7 months, and median overall survival of 23.0 months. EGFR TKI, EGFR-mutation type, and smoking status did not impact in the outcome of treated women. Conclusion. Prevalence of EGFR mutation in women with NSCLC is higher than overall population with NSCLC. Efficacy of EGFR TKI in this real-world setting is similar to that previously reported (AU)

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A consensus statement on the gender perspective in lung cancer

Lung cancer is the most common cancer globally and has the highest mortality. Although this disease is not associated with a particular gender, its incidence is rising among women, who are diagnosed at an increasingly younger age compared with men. One of the main reasons for this rise is women taking up smoking. However, many non-smoking women also develop this disease. Other risk factors implicated in the differential development of lung cancer in women are genetic predisposition, tumour histology and molecular profile. Proportionally more women than men with lung cancer have a mutation in the EGFR gene. This consensus statement reviews the available evidence about the epidemiological, biological, diagnostic, therapeutic, social and psychological aspects of lung cancer in women (AU)

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Long-term survival in advanced non-squamous NSCLC patients treated with first-line bevacizumab-based therapy

Background/Aim. First-line bevacizumab-based therapies have been shown to improve clinical outcomes in patients with non-squamous non-small-cell lung cancer (NSCLC). We aimed to descriptively analyse patients with non-squamous NSCLC who received a long-term period of maintenance bevacizumab. Patients and methods. This retrospective study included 104 patients who had already reached a progression-free survival (PFS) of at least 9 months. Results. Median overall survival and PFS were 30.7 and 15.1 months, respectively. The overall response rate was 83 %. Weight loss ≤5 %, ECOG PS = 0, or low number of metastatic sites seem to be predictive factors of good evolution. The incidence of bevacizumab-related adverse events appeared to be similar as the previous studies. Conclusion. Our findings show that there is a long-term survivor group whom the administration of bevacizumab resulted in a relevant prolongation of response without new safety signals. Due to the population heterogeneity, it was not possible to identify the standardised predictive factors (AU)

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SEOM Clinical Guideline update for the prevention of chemotherapy-induced nausea and vomiting (2016)

Chemotherapy-induced nausea and vomiting is one of the most worrisome adverse effects of chemotherapy for cancer patients. It can cause severe discomfort and affect the quality of life. In recent years, the incorporation of new drugs has increased the efficacy of antiemetic treatments in the control of emesis associated with chemotherapy. This guideline, in which we give some treatment recommendations with level of evidence and grade of recommendation, provides an update of the previously published guideline of the Spanish Society of Medical Oncology and represents our continued commitment to improving supportive care in cancer patients (AU)

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Biomarker testing in advanced non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology

In 2011, the Spanish Society of Medical Oncology and the Spanish Society of Pathology started a joint project to establish recommendations on biomarker testing in patients with advanced non-small-cell lung cancer based on the current evidence. Most of these recommendations are still valid, but new evidence requires some aspects to be updated. Specifically, the recommendation about which biomarkers to test in which patients is being amended, and the best way to manage tumour samples and minimum requirements for biomarker test material are defined. Suitable techniques for testing for epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangement are also reviewed, and a consensus is reached on which situations warrant re-biopsy (AU)

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Recomendaciones para el diagnóstico radiológico y la valoración de la respuesta terapéutica en el cáncer de pulmón. Consenso nacional de la Sociedad Española de Radiología Médica y la Sociedad Española de Oncología Médica / Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology

En esta última década se han producido avances importantes en el diagnóstico y tratamiento del cáncer de pulmón que han permitido mejorar su pronóstico. Por ello, la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Oncología Médica (SEOM) han elaborado un documento de consenso nacional para hacer recomendaciones sobre el diagnóstico radiológico y la valoración de la respuesta terapéutica en pacientes con cáncer de pulmón. Este grupo de expertos recomienda la tomografía computarizada multidetector (TCMD) como la técnica de elección para estudiar esta enfermedad, y respecto al informe radiológico incluir una valoración completa siguiendo el sistema de estadificación TNM. Por último, cuando el paciente reciba inmunoterapia, además de usar los criterios para evaluar la respuesta en tumores sólidos (Response Evaluation Criteria in Solid Tumors [RECIST 1.1]) también habrá que usar los criterios de respuesta inmunológica (Immune-Related Response Criteria [irRC]) (AU)

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM) have therefore produced a national consensus statement in order to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography (MDCT) as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only Response Evaluation Criteria in Solid Tumours (RECIST 1.1) but also Immune-Related Response Criteria (irRC) (AU)

Recommendations for radiological diagnosis and assessment of treatment response in lung cancer: a national consensus statement by the Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology

The last decade has seen substantial progress in the diagnostic and therapeutic approach to lung cancer, thus meaning that its prognosis has improved. The Spanish Society of Medical Radiology and the Spanish Society of Medical Oncology have therefore produced a national consensus statement to make recommendations for radiological diagnosis and assessment of treatment response in patients with lung cancer. This expert group recommends multi-detector computed tomography as the technique of choice for investigating this disease. The radiology report should include a full assessment by the TNM staging system. Lastly, when the patient is on immunotherapy, response evaluation should employ not only response evaluation criteria in solid tumours, but also immune-related response criteria (AU)

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Iron deficiency in patients with solid tumours: prevalence and management in clinical practice

PURPOSE: The objective of the present study was to describe the prevalence and management of anaemia and iron deficiency (ID) in treatment-naïve patients with solid tumours in Spain and the incidence of anaemia over 4 months of cancer treatment in clinical practice. METHODS: Multicentre, prospective and observational study in newly diagnosed cancer patients. Data on anaemia and iron parameters and its management were collected prior to the initiation of chemotherapy, at each cycle of chemotherapy and after 4 months of treatment. The main outcomes of the study were the prevalence of anaemia at baseline, its incidence during cancer treatment and the prevalence of absolute ID (AID) and functional ID (FID) prior to chemotherapy initiation. RESULTS: A total of 295 patients were included in the study. Anaemia was present at diagnosis in 38.6 % of patients and was treated only in 32.5 % of those. A total of 106 patients (60.2 %) without anaemia at baseline developed anaemia during cancer treatment. Serum ferritin and transferrin saturation data were available for 151 of the patients (51.2 %) included in the study. The overall prevalence of ID was 59 %: 48 patients (31.8 %) presented with AID and 41 patients (27.2 %) presented with FID before starting anti-cancer therapy. Thirty-three of 44 non-anaemic iron-deficient patients did not receive any type of iron supplementation before initiating cancer therapy. CONCLUSIONS: Iron parameters are not commonly measured in newly diagnosed cancer patients. A correct evaluation and early management of ID could reduce the incidence of treatment-related anaemia in cancer patients (AU)

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Lung cancer in women: an overview with special focus on Spanish women

Lung cancer incidence is decreasing worldwide among men but rising among women due to recent changes in smoking patterns in both sexes. In Europe, the smoking epidemic has evolved different rates and times, and policy responses to it, vary substantially between countries. Differences in smoking prevalence are much more evident among European women reflecting the heterogeneity in cancer incidence rates. Other factors rather than smoking and linked to sex may increase women's susceptibility to lung cancer, such as genetic predisposition, exposure to sex hormones and molecular features, all of them linked to epidemiologic and clinical characteristics of lung cancer in women. However, biological bases of sex-specific differences are controversial and need further evaluation. This review focuses on the epidemiology and outcome concerning non-small cell lung cancer in women, with emphasis given to the Spanish population (AU)

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Cisplatin puls oral vinorelbine as first-line treatment for advanced non-small-cell lung cancer: a prospective study confirming that the day-8 hemogram is unnecessary

INTRODUCTION: Cisplatin plus oral vinorelbine, one of the standard treatments for metastatic non-small-cell lung cancer (NSCLC), is associated with a high rate of neutropenia, and a hemogram is performed on day 8. We analyzed the oncologists' opinions and the result of the hemogram on day 8 to address the question of whether this hemogram could be avoided. MATERIALS AND METHODS: Fifty-eight chemotherapy-naive, advanced NSCLC patients were included. Each received intravenous doses of 75 mg/m(2) cisplatin on day 1 plus oral vinorelbine [60 mg/m(2) in the first cycle (80 mg/m(2) in subsequent cycles) on days 1 and 8], every 3 weeks, for a maximum of six cycles. RESULTS: Out of 257 cycles analyzed, oral vinorelbine was administered on day 8 in 214 (83.2 %) and the dose was canceled in 6 cycles (2.3 %) due to hematological toxicity. On analyzing the patients to whom chemotherapy had been administered on day 8, based on medical opinion without the doctor knowing the hemogram result, we found that the cycle had been administered with a hemogram showing fewer than 1,500 × 10(6) neutrophils in only 3 of the 185 evaluable cycles [event rate of 1.6 %, with confidence interval 95 % = (0.34-4.67 %)]. CONCLUSION: The hemogram on day 8 can be avoided and oral vinorelbine administered in relative safety in patients with good performance status, when confirmed by the clinician's perception, thereby making this regimen more comfortable for the patient. This is the first prospective study to examine this issue (AU)

SEOM clinical guidelines for myeloid growth factors

Neutropenia induced by chemotherapy (CT) is an infection risk factor associated to greater morbidity/mortality and dose-limiting toxicity that on many occasions requires a reduction of the dose of cytostatics or a delay in the administration of treatment. This may have a negative effect on the patient's quality of life and even diminish the efficacy of the treatment, especially when the intention is to cure or prolong survival. Management of treatment or prophylaxis of grade 3-4 neutropenia and febrile neutropenia with myeloid growth factors (CSF) varies very much in clinical practice, both in the time of starting treatment and the types of patients it is given to. The need to generalise and facilitate practice based on clinical evidence has led the Spanish Society of Medical Oncology (SEOM) to prepare clinical practice guidelines on the use of myeloid growth factors (AU)

Guidelines for biomarker testing in advanced non-small-cell lung cancer. A national consensus of the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP)

Patients with advanced non-small-cell lung cancer (NSCLC) carrying epidermal growth factor receptor (EGFR) mutations can now have specific treatment based on the result of biomarker analysis and patients with rearrangements of the anaplastic lymphoma kinase (ALK) gene will probably soon be able to. This will give them better quality of life and progression-free survival than conventional chemotherapy. This consensus statement was conceived as a joint initiative of the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP), and makes diagnostic and treatment recommendations for advanced NSCLC patients based on the scientific evidence on biomarker use. It therefore provides an opportunity to improve healthcare efficiency and resource use, which will undoubtedly benefit these patients. Although this field is in continuous evolution, at present, with the available data, this panel of experts recommends that all patients with advanced NSCLC of non-squamous cell subtype, or non-smokers regardless of the histological subtype, should be tested for EGFR gene mutations within a maximum of 7 days from the pathological diagnosis. Involved laboratories must participate in external quality control programmes. In contrast, ALK gene rearrangements should only be tested in the context of a clinical trial, although the promising data obtained will certainly justify in the near future its routine testing in patients with no EGFR mutations. Lastly, routine testing for other molecular abnormalities is not considered necessary in the current clinical practice (AU)

Monoclonal antibodies for medical oncology: a few critical perspectives

Incorporation of antibodies as weapons for cancer therapy has meant a turning point in the survival, clinical and radiological response of many oncology patients. These drugs are effective, well designed missiles that either alone or in combination with chemotherapy are unavoidable weapons for breast, lung and colon cancer as well as for haematological tumours. In addition, incoming monoclonal antibodies (mAbs) and folder-like proteins will be incorporated into clinical practice in the near future. This review aims to discuss a few imminent indications of current mAbs that are used for solid tumours and to briefly introduce future mAbs to the reader (AU)

Clinical-molecular factors predicting response and survival for tyrosine-kinase inhibitors

The development of drugs with special mechanisms of action, such as tyrosine kinase inhibitors (TKIs), means that new clinical-molecular questions are being examined and this will help us to better select from the treatments available. In this study we review questions of survival and response to TKIs, attempting to distinguish prediction-and prognosis-related factors, at both the clinical and molecular levels. The evidence available today allows us to affirm that the benefits of TKI treatment occur regardless of the patient's status as a smoker, his/her gender or histological sub-type. Interestingly, in a subset analysis of ever-smokers, men with squamous cell histology derived a statistically significant survival benefit from erlotinib, a population that was previously thought not to benefit. The question of who should receive TKIs is still not completely resolved. Therefore, there should be an international effort to achieve a prognostic index, as has been done for lymphomas, that combines molecular and clinical factors. Such an index would classify patients into several sub-groups, defining the likelihood of non-response to TKIs (AU)

Comparación de dos estrategias de vacunación frente a la hepatitis A y B en individuos con hepatitis crónica C / Comparison of two vaccination strategies against hepatitis A and B in patients with chronic hepatitis C

Objetivo: aunque se recomienda vacunar frente al virus de la hepatitis A (VHA) y al virus de la hepatitis B (VHB) a los pacientes con infección crónica por el virus de la hepatitis C (VHC), la estrategia de vacunación más costo-efectiva aún no está establecida. Nuestro objetivo fue comparar la vacunación universal (de todos los individuos) con la selectiva (únicamente de los individuos no inmunizados) frente al VHA y al VHB de los pacientes con infección crónica por VHC en nuestro medio. Pacientes y métodos: comparamos los costes directos de las dos estrategias de vacunación frente a ambos virus en 313 individuos con infección crónica por VHC. Determinamos los marcadores serológicos del VHA (anti-VHA) y del VHB (HBsAg, anti-HBs y anti-HBc) y tuvimos en cuenta los costes de vacunas y reactivos en nuestro ámbito. Resultados: la prevalencia de anti-VHA fue del 81,2% y la de anti-HBc del 24,6%. La prevalencia de anti-VHA aumentaba progresivamente con la edad. La inmunización frente al VHA suponía 19.806,64 € con la estrategia universal y 9.899,62 € con la selectiva. La vacunación frente al VHB ascendía a 18.780 € con la inmunización universal y a 20.385,57 € con la selectiva (mediante el anti-HBc). Se analizaron los costes considerando distintos grupos etarios y diversos factores de riesgo. Conclusiones: en nuestros individuos con infección crónica por VHC la vacunación selectiva frente al VHA es la más costoefectiva. Pero cuando el porcentaje de inmunización frente al VHA desciende por debajo del 20% la mejor opción es la universal. La diferencia en la costoefectividad de ambas estrategias de vacunación frente al VHB es pequeña, a favor de la universal, por lo que en subgrupos con elevada prevalencia de anti-HBc, como adictos a drogas y tatuados, la selectiva podría ser la mejor alternativa(AU)

Objective: although the vaccination against hepatitis A (VAH) and hepatitis B (VBH) is recommended in patients with HCV, the most cost-effective strategy has not been established. Our objective was to compare the cost-effectiveness of universal strategy (vaccination all patients) with selective strategy (vaccination only patients against virus they lack immunity to) in patients with HCV. Patients and methods: we compared the direct medical costs of the two vaccination strategies against both viruses in 313 patients with HC. Serological markers for HAV (anti-HAV) and HBV (HbsAg, anti HBs, anti HBc) were determined in the 313 patients and the costs of the vaccines and the blood tests necessary to determinate the immunity state in our care system were considered. Results: the prevalence of anti-HAV was 81,2% and of anti-HBc was 24,6%. The prevalence of anti-HAV increases with age. HAV vaccination with universal strategy has a cost of 19.806,64 € and with selective one of 9.899,62 €. HBV vaccination with universal strategy rose to 18.780 € and to 20.385,57 € with selective one (employing anti-HBc). Costs were analysed in different groups of age and several hepatitis HBV risk factors. Conclusions: the selective vaccination strategy against HAV was most cost-effective in our patients with HCV. However, when the prevalence of the anti-HAV decreased to less than 20% universal strategy will be the best option. Difference of cost-effective between the two vaccination strategies against HBV was small, on behalf of universal one, so in groups with higher anti-HBc prevalence, like parenteral drugs users and tattoos, the selective strategy could be the best option(AU)

Cardiac toxicity: old and new issues in anti-cancer drugs

Although rare, cardiotoxicity is a significant complication of cancer treatment. The incidence and severity of cardiovascular side effects are dependent on the type of drugs used, dose and schedule employed, and age of patients, as well as the presence of coexisting cardiac diseases and previous mediastinal irradiation. Classically, anthracyclines are among one of the most active agents in oncology, but their use is often hampered by their cumulative dose-limiting cardiotoxicity. In the past decade, combination therapy with new drugs such as taxanes or anti- EGFR, and Her-2 therapy as a single agent have also resulted in unexpected cardiotoxicity. Cardiac damage can be secondary to an alteration of cardiac rhythm, changes in blood pressure and ischaemia, and can also alter the ability of the heart to contract and/or relax. The clinical spectrum of these toxicities can range from subclinical abnormalities to being catastrophic, life-threatening and sometimes fatal. Knowledge of this toxicity can aid clinicians to choose the optimal and least toxic regimen suitable for an individual patient. In this work we present an exhaustive review of the cardiovascular side effects associated to new anticancer drugs, from new formulations of anthracyclines to tyrosine kinase inhibitors and monoclonal antibodies (AU)

Molecular markers in colorectal cancer: genetic bases for a customised treatment

Colorectal cancer (CRC) is the second leading cause of cancer death in Western countries. CRC treatment is based on the employment of three chemotherapeutic drugs, including 5-fluorouracil, oxaliplatin and irinotecan, and the use of recently incorporated targeted agents directed to vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR). The approval of these biologicals and of others to come holds great promise for the improvement of patient outcome. The molecular bases for this lethal disease have been extensively investigated, laying the foundations for a rational and customised treatment approach, expanding the therapeutic index of current drugs and easing the incorporation of new molecules. Individual markers have been mainly investigated based on drug targets and metabolism. Also, the increasing availability of highthroughput technologies has prompted the opportunity for blind studies capable of screening new markers and of identifying the specific oncogenic pathways responsible for drug resistance in a given patient. An updated review of the field is presented in this article (AU)

Diagnóstico serológico de la mononucleosis infecciosa / Serologic diagnostic of infectious mononucleosis

El virus de Epstein Barr (VEB) es el agente etiológico habitual de la mononucleosis infecciosa clásica. En este artículo recogeremos los resultados de dos ensayos utilizados en nuestro laboratorio para el diagnóstico serológico de la mononucleosis infecciosa producida por el VEB (Clearview IM y Enzywell Epstein Barr VCA IgM) junto a los de dos ensayos adicionales (Enzywell Epstein Barr EA IgG y Enzywell Epstein Barr EBNA IgG) al efecto de valorar sus ventajas relativas en el diagnóstico de la mononucleosis. La importancia del diagnóstico estriba en sus potenciales complicaciones en el paciente, que podrían llegar a provocar su muerte (AU)

Estudio de la anemia en los pacientes diagnosticados de cáncer en el período de un año / Study of anemia for a year of patients diagnosed of cancer

Propósito: Realización de estudio descriptivo y determinación de la relación entre la anemia en pacientes oncológicos y los distintos factores que la condicionan: como edad, sexo, tipo de tratamiento, tipo de tumor y extensión de la enfermedad. Material y métodos: estudiamos un total de 413 pacientes diagnosticados en las consultas de Oncología Médica del hospital La Paz en el periodo de un año (marzo 96-marzo 97). Se definió anemia grave Hb <=10,5. Anemia leve entre esta cifra y Hb = 12 si se trataba de una mujer, o Hb = 13 si era un hombre. En ambos tipos se recogió si se produjo en el diagnóstico, durante el tratamiento activo o en la fase de tratamiento sintomático Se consideró también la cifra de hemoglobina más baja y su relación con evolución de la enfermedad remisión, estabilización o progresión).Resultados: El 70,3 por ciento desarrollaron anemia, de estos el 68 por ciento durante el tratamiento activo. La mitad fueron anemias leves. El 8 por ciento necesitó una transfusión. La causa de la anemia fue el propio tumor en el 19 por ciento de los casos, la QT en el 36 por ciento y mixta (C+RT+QT) en el 42 por ciento. El 82 por ciento de los pacientes con ca. de pulmón, el 78 por ciento de ca. colorrectal y el 88 por ciento de otros tumores gastrointestinales tuvieron anemia en algún momento de su evolución. Esto resulta estadísticamente significativo (p < 0.0004) respecto al resto de neoplasias. La probabilidad de presentar anemia es mayor para los que reciben QT-RT (IC95 por ciento0R: 1,42-6,52), cis o carboplatino OR: 12,77 (IC95 por cientoOR: 3,77-51,94), el sexo masculino (IC95 por cientoOR: 1,34-3,37). Con respecto a la presencia de metástasis, su relación con la anemia se encuentra al borde de la significación estadística (p=0,06), desarrollando anemia el 77,3 por ciento (58/75) de los que presentaban metástasis frente al 64,8 por ciento (81/125) de los que no. Se obtienen resultados similares si consideramos tan solo las anemias de tipo leve. Respecto a la anemia grave: Es más probable en los que reciben cis o carboplatino (IC95 por cientoOR: 4,33-14,88), en la presencia de metástasis (IC95 por ciento0R: 1,93-7,12), y en los menores de 65 años (IC95 por ciento0R: 1,12- 2,69). Ni la QT-RT, ni el sexo aportan diferencias. En los pacientes que desarrollaron anemia grave la enfermedad se encontraban en progresión en el 60 por ciento, en remisión en el 10 por ciento, y controlada en el 30 por ciento, frente al 32 por ciento de progresiones, 58 por ciento de remisiones y 10 por ciento de control de la enfermedad, entre los pacientes que no la desarrollaron (p < 0.0001).Conclusiones: La incidencia de anemia en los pacientes oncológicos es muy alta, en más de la mitad la anemia es de carácter leve. La causa más importante es el tratamiento quimioterápico (especialmente cisplatin). Es más frecuente en el cáncer de pulmón, colorrectal y otros gastrointestinales, por este orden. La probabilidad de desarrollar una anemia grave es mayor en los pacientes con metástasis, en los menores de 65 años, y en los que reciben cis o carboplatino. La progresión de la enfermedad es significativamente mayor en los pacientes cuya hemoglobina fue menor de 10.5 en algún momento de su evolución (AU)