EPO promotes survival of cancer cells

1. 2003 EPO compromised survival In head and neck cancer pt. 2003 EPO compromised survival In breast cancer (>12Hb). BEST 2003 EPO accelerated breast cancer Progression . BEST 2006 EPO promoted local relapse Head and Neck Ca, EPOR+ 2000 Tumors produce EPO Cancer cells express EPO-R 2001 EPO promotes survival of cancer cells 2002 EPO is a growth factor for cancer cells 2002 EPO promotes cancer angiogenesis 2003 2003 EPO protects cancer cells from apoptosis

3. 2006

4. 2006

5. 2006

6. 2006 EPO receptors are present at the invasion front of the tumor cells.

7. 2003 EPO compromised survival In head and neck cancer pt. 2003 EPO compromised survival In breast cancer (>12Hb). BEST 2003 EPO accelerated breast cancer Progression. BEST 2006 2006 EPO promoted local relapse Head and Neck Ca, EPOR+ Cervix Ca pt. with EPOR+ have poorer survival and more LVI 2000 Tumors produce EPO Cancer cells express EPO-R 2001 EPO promotes survival of cancer cells 2002 EPO is a growth factor for cancer cells 2002 EPO promotes cancer angiogenesis 2003 2003 EPO protects cancer cells from apoptosis

8. 2007

10. 2007 1 DAHANCA study 484 patients Head and Neck cancer Good stratification Placebo EPO

11. 2007 Overall failure

12. 2003 EPO compromised survival In head and neck cancer pt. 2003 EPO compromised survival In breast cancer (>12Hb). BEST 2003 EPO accelerated breast cancer Progression. BEST 2006 2006 EPO promoted local relapse Head and Neck Ca, EPOR+ Cervix Ca pt. with EPOR+ have poorer survival and more LVI 2007 DAHANCA: 10% local relapse in EPO treated pt. Trend for worse Survival. 2000 Tumors produce EPO Cancer cells express EPO-R 2001 EPO promotes survival of cancer cells 2002 EPO is a growth factor for cancer cells 2002 EPO promotes cancer angiogenesis 2003 2003 EPO protects cancer cells from apoptosis

13. 2007

14. 4.2007

15. 2 “103 study” 2007 Supportive, patients not on chemotherapy 965 patients EPO vs Placebo

16. 2007

17. 2007

18. 2007

19. 2003 EPO compromised survival In head and neck cancer pt. 2003 EPO compromised survival In breast cancer (>12Hb).BEST 2003 EPO accelerated breast cancer Progression. BEST 2006 2006 EPO promoted local relapse Head and Neck Ca, EPOR+ Cervix Ca pt. with EPOR+ have poorer survival and more LVI 2007 DAHANCA: 10% local relapse in EPO treated pt. Trend for worse Survival. 2007 Study 103: No reduced transfusion needs In cancer pt. not on chemo. Worse survival. 2000 Tumors produce EPO Cancer cells express EPO-R 2001 EPO promotes survival of cancer cells 2002 EPO is a growth factor for cancer cells 2002 EPO promotes cancer angiogenesis 2003 2003 EPO protects cancer cells from apoptosis

20. 2007 Canadian study

21. 2007

22. 2003 EPO compromised survival In head and neck cancer pt. 2003 EPO compromised survival In breast cancer (>12Hb). BEST 2003 EPO accelerated breast cancer Progression. BEST 2006 2006 EPO promoted local relapse Head and Neck Ca, EPOR+ 2007 Cervix Ca pt. with EPOR+ have poorer survival and more LVI 2007 DAHANCA: 10% local relapse in EPO treated pt. Trend for worse Survival. 2007 Study 103: No reduced transfusion needs In cancer pt. not on chemo. Worse survival. Canadian study: Worse survival, not improved QOL. 2000 Tumors produce EPO Cancer cells express EPO-R 2001 EPO promotes survival of cancer cells 2002 EPO is a growth factor for cancer cells 2002 EPO promotes cancer angiogenesis 2003 2003 EPO protects cancer cells from apoptosis

23. 2007 3 “145 study”

24. 2003 EPO compromised survival In head and neck cancer pt. 2003 EPO compromised survival In breast cancer (>12Hb). BEST 2003 EPO accelerated breast cancer Progression. BEST 2006 2006 EPO promoted local relapse Head and Neck Ca, EPOR+ 2007 Cervix Ca pt. with EPOR+ have poorer survival and more LVI 2007 DAHANCA: 10% local relapse in EPO treated pt. Trend for worse Survival. 2007 Study 103: No reduced transfusion needs In cancer pt. not on chemo. Worse survival. Canadian study: Worse survival, not improved QOL. 2000 Tumors produce EPO Cancer cells express EPO-R 2001 EPO promotes survival of cancer cells 2002 EPO is a growth factor for cancer cells 2002 EPO promotes cancer angiogenesis 2003 2003 EPO protects cancer cells from apoptosis 2007 Study 145: No survival compromise Lung patients.

25. 2007

26. 2007

27. 2007 10.5.07

29. Conclusions 2007 EPO The Illusion of Relativity

30. 2000 Tumors produce EPO Cancer cells express EPO-R 2001 EPO promotes survival of cancer cells 2002 EPO is a growth factor for cancer cells 2002 EPO promotes cancer angiogenesis 2003 ACTIVITY SAFETY 2003 EPO protects cancer cells from apoptosis 2003 EPO compromised survival In head and neck cancer pt. 2003 EPO compromised survival In breast cancer (>12Hb). BEST 2003 EPO accelerated breast cancer Progression. BEST 2006 EPO promoted local relapse Head and Neck Ca, EPOR+ 2006 Cervix Ca pt. with EPOR+ have poorer survival and more LVI 2007 2007 DAHANCA: 10% local relapse in EPO treated pt. Trend for worse Survival. 2007 Study 103: No reduced transfusion needs In cancer pt. not on chemo. Worse survival. Canadian study: Worse survival, not improved QOL. 2007 Study 145: No survival compromise Lung patients.

31. Escher: The art of making possible the mathematicly impossible in order to reach the highest level of impossibility. The art of making statistically possible what is clinically irrelevant, leaving the clinician with the highest level of confusion. Than, what is clinically relevant?

32. EPO

37. But, would patients will accept participating in such clinical trials????