title: Standards of care for anemia management in oncology: focus on lung carcinoma.
abstract: BACKGROUND
  Anemia is common in patients with lung carcinoma, particularly among those undergoing platinum-based cytotoxic chemotherapy. Evidence is growing that anemia can have a profound impact on the patient's quality of life, often manifested as the patient's inability to function normally.
  
  
  METHODS
  A literature review was conducted to provide a current picture of the incidence and impact of anemia in patients with lung carcinoma and the usage and limitations of current treatment.
  
  
  RESULTS
  The incidence of anemia (a hemoglobin [Hb] level < 11g/dL) in lung carcinoma patients is approximately 50-60%, varying according to treatment regimen. However, despite evidence supporting the treatment of anemia, many clinicians only intervene when Hb levels fall below 8 g/dL. This may be because of a lack of awareness of the incidence and impact of anemia on cancer patients, but most likely is because of limitations of current treatment options (blood transfusion and recombinant human erythropoietin [epoetin-alpha]). Darbepoetin-alpha represents a new generation of erythropoiesis-stimulating proteins. Biochemically distinct from epoetin-alpha, darbepoetin-alpha has a greater sialic acid content and biologic half-life than epoetin-alpha, but stimulates erythropoiesis in the same manner. Clinical trials involving patients with cancer-related anemia have shown that darbepoetin-alpha has a threefold longer half-life than epoetin-alpha, which may allow less frequent dosing. The results from an ongoing clinical trial dedicated to testing the clinical benefits of darbepoetin-alpha in treating anemia in lung carcinoma patients will provide a valuable insight into its full potential in this setting.
  
  
  CONCLUSIONS
  Anemia is common but is reported to be undertreated in patients with lung carcinoma. The introduction of darbepoetin-alpha into clinical practice may overcome some of the limitations of current treatments and facilitate improvement in the management of cancer-related anemia.
authors.affiliation: Department of Thoracic Oncology, Fox Chase Cancer Center, 7701 Burholme Avenue, Philadelphia, PA 19111, USA. CJ_Langer@fccc.edu
authors.forename: Corey J
authors.initials: CJ
authors.lastname: Langer
authors.forename: Hak
authors.initials: H
authors.lastname: Choy
authors.forename: John A
authors.initials: JA
authors.lastname: Glaspy
authors.forename: Alan
authors.initials: A
authors.lastname: Colowick
mesh_terms: D000740:Anemia / Q000139:chemically induced / Q000150:complications / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000068256:Darbepoetin alfa; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D017671:Platinum Compounds / Q000009:adverse effects; D011788:Quality of Life
chemical_list: D006454:Hemoglobins; D017671:Platinum Compounds; D004921:Erythropoietin; D000068256:Darbepoetin alfa