Erythropoiesis-stimulating agents (ESAs): do they still have a role in chemotherapy-induced anemia (CIA)?
OBJECTIVE
Anemia in cancer patients can be a result of the underlying cancer or related to treatment. Erythropoiesis-stimulating agents (ESAs) are an important option for many patients with chemotherapy-induced anemia, but are immersed in controversy. This article aims to reconcile conflicting opinions and provide expert guidance for appropriate ESA use.


METHODS
Teleconference, email, and a face-to-face meeting were used to assess ESA therapy "interpretive" data, which included two current meta-analyses, expert guidelines, and regulatory approved indications from Canada, Europe, and the USA.


RESULTS
Risks and benefits are associated with both red blood cell transfusions and ESA therapy, including improvements in hemoglobin levels and quality of life. ESAs have been associated with concerns regarding survival and progression of cancer, particularly when used in patients with cancer-related anemia.


CONCLUSIONS
Although safety concerns do exist, ESA therapy can be considered for use in patients with chemotherapy-induced anemia in accordance with Health Canada labeling.
The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada. jbormanis@toh.on.ca
Janis
J
Bormanis
Ian
I
Quirt
José
J
Chang
C Tom
CT
Kouroukis
David
D
MacDonald
Barb
B
Melosky
Sunil
S
Verma
Felix
F
Couture
D000740:Anemia / Q000139:chemically induced* / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D017063:Outcome Assessment, Health Care
D000970:Antineoplastic Agents; D006397:Hematinics
Anemia; Chemotherapy-induced anemia; ESA; Erythropoiesis-stimulating agents