title: Standard of care for cancer-related anemia: improving hemoglobin levels and quality of life.
abstract: The introduction of recombinant human erythropoietin (rHuEPO) has proven to be a major advance in the therapeutic options available for managing anemia in cancer patients. The results of placebo-controlled clinical trials and large, community-based, open-label studies have confirmed that epoetin alfa, a recombinant human erythropoietin, significantly reduces transfusion requirements, and reliably increases hemoglobin (Hb) levels in anemic (Hb level <12 g/dl) cancer patients undergoing chemotherapy. Increased Hb improves patients' energy level and their ability to perform the activities of daily living, as well as their overall quality of life (QOL). These findings are independent of tumor type and disease status and are comparable in patients receiving nonplatinum- and platinum-based chemotherapeutic regimens. Furthermore, more than a decade of use in clinical trials and by physicians in routine clinical practice has demonstrated that epoetin alfa is safe and well tolerated when used to treat cancer patients with anemia. The availability of epoetin alfa as an alternative to transfusion has changed practices in anemia management; physicians can now treat anemia with the goal of achieving adequate Hb levels to relieve anemia-related fatigue, a major symptom contributing to decreased QOL in cancer patients. Incremental benefit analysis has shown that increasing Hb level from 11 g/dl to 12 g/dl yields the greatest improvement in QOL per 1 g/dl increase in Hb. The demonstrated efficacy of epoetin alfa for increasing Hb levels and improving patient QOL have made this agent a rationale choice for management of cancer-related anemia. Ongoing research will continue to provide new insights into best management of anemia with epoetin alfa in cancer patients.
authors.affiliation: Dipartimento Medicina Sperimentale e Patologia, Università di Roma, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cortesi
authors.forename: Pere
authors.initials: P
authors.lastname: Gascón
authors.forename: David
authors.initials: D
authors.lastname: Henry
authors.forename: Timothy
authors.initials: T
authors.lastname: Littlewood
authors.forename: Robert
authors.initials: R
authors.lastname: Milroy
authors.forename: Paolo
authors.initials: P
authors.lastname: Pronzato
authors.forename: Uwe
authors.initials: U
authors.lastname: Reinhardt
authors.forename: Daniel
authors.initials: D
authors.lastname: Shasha
authors.forename: Nicholas
authors.initials: N
authors.lastname: Thatcher
authors.forename: Peter
authors.initials: P
authors.lastname: Wilkinson
mesh_terms: D000747:Anemia, Hypochromic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D018849:Controlled Clinical Trials as Topic; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000523:psychology; D011788:Quality of Life; D011994:Recombinant Proteins; D012720:Severity of Illness Index
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa