Анемия в онкологии: подходы к лечению

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Аннотация

Анемия – распространенное осложнение неопластических заболеваний. Помимо значимого ухудшения качества жизни, она ассоциируется с возможностью стимуляции неоангиогенеза, повышения агрессивности опухоли и снижения ее чувствительности к радио- и химиотерапии. Анализ данных десятков исследований свидетельствует об ухудшении общей выживаемости онкологических больных с анемией. Современные методики коррекции анемии опухолевого заболевания включают заместительные гемотрансфузии и назначение рекомбинантных эритропоэтинстимулирующих протеинов (ЭСП) – эритропоэтина и дарбепоэтина. Переливание эритроцитов донора позволяет быстро увеличить уровень гемоглобина, однако имеется риск трансфузиологических реакций, передачи инфекции и гемосидероза внутренних органов. Существенным недостатком метода является кратковременность эффекта. Применение ЭСП позволяет надежно и длительно увеличить содержание гемоглобина крови у 60–70% онкологических больных. Последние годы применение ЭСП у онкологических больных дискутируется в связи с наблюдениями возможного негативного влияния на опухоль за счет стимуляции эритропоэтиновых рецепторов на неоплазированных клетках. Эта дискуссия привела к рекомендации применения ЭСП только на фоне химиотерапии и в минимальных дозах, обеспечивающих свободу от гемотрансфузий. Недавно опубликованные масштабные исследования по применению дарбепоэтина у больных с лимфомами и раком молочной железы показали, что применение ЭСП в рамках зарегистрированных показаний не только безопасно, но и сопровождается увеличением безрецидивной выживаемости. Еще более увеличить эффективность ЭСП и снизить их дозу позволяет назначение внутривенных препаратов железа, из которых сахарат и глюконат железа являются наиболее безопасными с точки зрения острой токсичности.

Ключевые слова: рак, анемия, эритропоэтин, дарбепоэтин, сахарат железа.

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Anemia is a common complication of neoplastic diseases. In addition to significant worsening of quality of life, it is associated with the possibility of stimulating neongiogenesis, enhancing the aggressiveness of a tumor, and reducing its susceptibility to radio- and chemotherapy. Analysis of the data of tens of studies suggests the lower overall survival rates in cancer patients with anemia. Current methods for correction of anemia in tumor disease comprise replacement blood hemotransfusions and use of recombinant erythropoietin-stimulating proteins (ESP), such as erythropoietin and darbepoietin. Donor red blood cell transfusion allows hemoglobin levels to be rapidly increased; however, there is a risk of transfusion reactions, infection transmission, and hemosiderosis of the viscera. The obvious pitfall in the method is its short-term effect. The application of ESP permits a reliable and long-term increase in blood hemoglobin levels in 60–70% of cancer patients. The use of ESP in cancer patients has been recently under discussion due to observations of its possible negative impact on the tumor, by stimulating erythropoietin receptors in the neoplastic cells. This discussion has led to the recommendation for ESP use only during chemotherapy and in the minimal doses achieving a freedom from blood transfusions. Recently published large-scale studies of darbepoietin used in patients with lymphomas or breast cancer have shown that the administration of the ESP in cases of the registered indications is not only safe, but also it is followed by higher relapse-free survival rates. The efficacy of ESPs can be further increased and their dose be further decreased by the injection of intravenous iron supplements, of which ferrous saccharate and ferrous gluconate are safest in terms of acute toxicity.

Key words: cancer, anemia, erythropoietin, darbenopoietin, iron saccharate.

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Авторы

В.В.Птушкин

Федеральный научно-клинический центр детской гематологии, онкологии и иммунологии Минздравсоцразвития РФ, Москва

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V.V.Ptushkin

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