Anemia Drugs Up Cancer Death Risk
Study Shows More Deaths, Blood Clots in Cancer Patients Taking Procrit, Epogen, Aranesp
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Anemia Drug Benefits Overrated, Risks Underrated? continued...
"We thought that receptor was found only on blood stem cells, so the drugs' effects would be very precise," Lai tells WebMD. "But then we saw that brain cells also had the receptor, and that the drugs help some blood vessels to develop. And then someone got the idea to see if cancer cells have it. Sure enough, all these different solid tumors express the receptor."
The effect on tumor cells, Lai says, is to help them invade deeper into the body.
Meanwhile, U.S. doctors began using more and more of the drugs. Instead of using the drugs to bring patients' red blood cell counts up to minimum levels, they began using it to bring blood cell counts as close to normal as possible. Fueling the process was a rebate scheme in which the companies making the drugs paid doctors millions of dollars to give the drugs to their patients.
"We had a class of drug approved for a very specific indication. But through a variety of professional concerns and legitimate patient interests -- combined with heavy advertising and doctor-reimbursement policies -- we expanded use of these drugs beyond their original intent," Len Lichtenfeld, MD, deputy chief medical officer at the American Cancer Society, tells WebMD.
The unchecked use of Procrit, Epogen, and Aranesp began to unravel in May 2006, when a research review by the U.S. Agency for Healthcare Research and Quality showed that the drugs increased patients' risk of deadly blood clots.
But Lichtenfeld says what really shocked cancer doctors was the FDA's January 2007 release of a "Dear Health Care Professional" letter from Aranesp maker Amgen. The letter informed doctors that cancer patients no longer on chemotherapy but still taking Aranesp appeared to die more often than patients not taking it.
Now the Bennett study confirms this suspicion -- and strongly suggests that it applies to the entire class of ESA drugs.
Whither Procrit, Epogen, Aranesp?
Procrit, Epogen, and Aranesp are top-selling drugs. Until the mid-March FDA panel meeting, it won't be clear exactly how doctors should use the medications.