Erythropoiesis Stimulating Agents: A Personal Journey

Extract

I write this editorial in deference to the many experts who devote their careers to this important field. In this editorial, I simply report the journeyman route of a medical oncologist who is desperately trying to improve the outcomes of women suffering from breast cancer.

At the end of the 1990s, there was much hope that erythropoiesis stimulating agents (ESAs) would improve the survival of cancer patients. It was all so very obvious. Elegant partial oxygen pressure (pO2) histograms showed differential oxygenation between normal and malignant tissues, and patients with higher tumoral pO2 were demonstrated to have improved survival (1,2). Beverly Teicher had shown the oxygen-dependency of cancer and had published oxygen enhancement ratios for the representative members of the key mechanistic classes of anticancer agents. Preclinical models had shown that erythropoietin restored the anemia-induced reduction in antineoplastic cytotoxicity, eg, cyclophosphamide (3). Hence, the ESAs, by raising hemoglobin levels, improving oxygenation, and increasing cytotoxicity of our antineoplastics, simply must improve survival!