American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer.
OBJECTIVE
To update American Society of Hematology/American Society of Clinical Oncology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.


METHODS
An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched.


RESULTS
The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews.


CONCLUSIONS
For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels ≥ 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration-approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations.
Medical College of Wisconsin, Milwaukee, WI, USA.
J Douglas
JD
Rizzo
Melissa
M
Brouwers
Patricia
P
Hurley
Jerome
J
Seidenfeld
Murat O
MO
Arcasoy
Jerry L
JL
Spivak
Charles L
CL
Bennett
Julia
J
Bohlius
Darren
D
Evanchuk
Matthew J
MJ
Goode
Ann A
AA
Jakubowski
David H
DH
Regan
Mark R
MR
Somerfield
D000328:Adult; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D000068256:Darbepoetin alfa; D018450:Disease Progression; D004921:Erythropoietin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D011994:Recombinant Proteins
D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa