Tutorial questions: Week 2

These questions are to be discussed in the Q & A forum. Please post your answers
in a separate thread so that it is easy for me to monitor who is actively involved in the
discussion.

1. Anaemia occurs when the Hb falls below the normal value of 130g/L in both
men and women
False
2. Define EPO and what are the primary sites of EPO production?
EPO is the principle growth factor that regulates the circulation of red blood
cells by ensuring that erythroid precursors in the bone marrow survive,
proliferate and differentiate into mature red blood cells. In foetuses, the
primary site of production is the liver and in adults, it is the kidney.
For Q2 you could also mention what specific cells in the kidney are
responsible and for Q7, maybe mention one pathway, Jak2 (tyrosine kinase
janus 2)

3. rhEPO has been shown to improve quality of life of anaemic cancer patients
by increasing transfusion requirements.
False
4. What were the deleterious effects of rhEPO reported in 2003?
The BEST trial showed a higher mortality rate after 12 months in patients who
received chemotherapy and epoetin alfa than those who just received
chemotherapy. The ENHANCE trial showed that patients treated with epoetin
beta before radiotherapy fared worse from treatment-related anaemia than
those who were not.
5. What were the adverse events associated with administering Erythropoiesis
stimulating agents (ESAs) to cancer patients?
Administering ESAs to cancer patients has been associated with increased
risk of venous thrombosis and cardiovascular events. It may also be
associated with a direct tumour promoting effect on erythropoietin receptor
positive cancer cells.
6. Regulation of the human EPO gene is regulated primarily by?
Hypoxia
7. How many main EPO-signalling pathways have been proposed
Four
8. What is meant by the FDA 2008 statement “that the drugs (rhEPO) should not
be used in patients whom cancer therapy was administered with curative
intent”?
It is meant that rhEPO should only be used where cancer therapy is
administered to prolong the life of terminal patients or to those who have a
higher risk of reoccurring cancer rather than those who are intended to be
cured entirely of cancer cells by the cancer therapy.

9. What do you think the future use of rhEPO in cancer patients should be?
I agree with the FDA statement that rhEPO should not be used in patients
who are receiving cancer therapy with curative intent as its adverse side
effects seem to be quite common and dangerous.