Experimental Drugs for Chemotherapy- and Cancer-Related Anemia

Clelia Madeddu,1 Manuela Neri,2 Elisabetta Sanna,2 Sara Oppi,3 Antonio Macciò2 1Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 2Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, Italy; 3Hematology and Transplant Center, A. Businco Hospital, ARNAS G. Brotzu, Cagliari, ItalyCorrespondence: Antonio Macci&#x00F2A. Businco Hospital, ARNAS G. Brotzu, via Jenner, Cagliari, 09100, ItalyTel +390706754228Email antoniomaccio56@gmail.comAbstract: Anemia in cancer patients is a relevant condition complicating the course of the neoplastic disease. Overall, we distinguish the anemia which arises under chemotherapy as pure adverse event of the toxic effects of the drugs used, and the anemia induced by the tumour-associated inflammation, oxidative stress, and systemic metabolic changes, which can be worsened by the concomitant anticancer treatments. This more properly cancer-related anemia depends on several overlapping mechanism, including impaired erythropoiesis and functional iron deficiency, which make its treatment more difficult. Standard therapies approved and recommended for cancer anemia, as erythropoiesis-stimulating agents and intravenous iron administration, are limited to the treatment of chemotherapy-induced anemia, preferably in patients with advanced disease, in view of the still unclear effect of erythropoiesis-stimulating agents on tumour progression and survival. Outside the use of chemotherapy, there are no recommendations for the treatment of cancer-related anemia. For a more complete approach, it is fundamentally a careful evaluation of the type of anemia and iron homeostasis, markers of inflammation and changes in energy metabolism. In this way, anemia management in cancer patient would permit a tailored approach that could give major benefits. Experimental drugs targeting hepcidin and activin II receptor pathways are raising great expectations, and future clinical trials will confirm their role as remedies for cancer-related anemia. Recent evidence on the effect of integrated managements, including nutritional support, antioxidants and anti-inflammatory substances, for the treatment of cancer anemia are emerging. In this review article, we show standard, innovative, and experimental treatment used as remedy for anemia in cancer patients.Keywords: hemoglobin, cancer-related anemia, chemotherapy-induced anemia, energy metabolism, inflammation, iron homeostasis, erythropoietin, interleukin-6