Guidelines Released Governing Use of Anti-Anemia Drugs

By Rachael Myers Lowe, cancerpage.com 

(September 13, 2002) - Most cancer patients develop anemia either because of their cancer or because of the radiotherapy or chemotherapy administered to fight it. Anemia, which is a deficit of oxygen carrying red-blood cells, can lead to debilitating fatigue and is considered a serious clinical problem.

Traditionally, anemia was treated with blood transfusions. But blood transfusions can be inconvenient and can carry risks of infection. In addition, blood supplies can be a problem.

In recent years, researchers have investigated the use of a protein, epoetin (recombinant human growth factor erythropoietin,) to stimulate red blood cell production in the bone marrow. Erythropoietin is a naturally occurring enzyme produced in the kidney and liver that signals the bone marrow to ramp-up its red blood cell production. Man-made versions of this enzyme are sold under the brand names Procrit (Ortho Biotech) and Epogen (Amgen.)

Epoetin is often prescribed for cancer-related anemia despite some uncertainties about when it should be used and its usefulness.

A panel of oncology and hematology experts has examined the literature and now the American Society of Clinical Oncology (ASCO) and the American Society of Hematology have developed guidelines for epoetin use in cancer, which will be published in the Journal of Clinical Oncology October 1^st.

The guidelines recommend adding epoetin as a standard treatment option for patients suffering from severe chemotherapy-induced anemia with a hemoglobin count of less than 10g/dL. Patients with moderate anemia (hemoglobin count of 10g/dL to 12g/dL) should be judged on an individual basis. For instance, some patients with moderate anemia may be candidates for epoetin because of other health problems such as advanced age along with heart disease.

The ASCO guidelines recommend administration of epoetin three times a week for a minimum of four weeks. If the patient has not responded, despite adjustments in dosing, between 6 and 8 weeks, discontinuing use should be considered. And once the a low hemoglobin count rises to 12g/dL, the guidelines recommend scaling treatment back to maintain that level or discontinuing use until hemoglobin levels fall below 10g/dL again.

In the case of anemia caused by cancers such as myelodysplasia, multiple myeloma, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia the evidence isn’t as compelling for epoetin use until efforts have been made to control the cancer first.

“Physicians caring for patients with myeloma, non-Hodgkin’s lymphoma, or chronic lymphocytic leukemia are advised to begin treatment with chemotherapy and/or corticosteroids and observe the hematologic response outcomes achieved solely through tumor reduction before considering epoetin,” the guidelines state.

Because of one well-designed, placebo-controlled trial, the experts conclude that patients with low-risk myelodysplasia, a bone marrow disease, may be candidates for epoetin use for an eight-week cycle. 

Left open for future research is the role longer acting epoetin formulations may play in the treatment of cancer related anemia. Darbepoetin alfa developed by Amgen under the brand name Aranesp, is administered only once per chemo treatment cycle, instead of 3 times a week. The panel said research on darbepoetin was sufficiently promising to warrant review once the data is available.

FOR MORE INFO:

• For Info about Procrit, click here. 
• For info about Epogen, click here. 
• For info about Aransep, click here
• For More information about Anemia, visit the cancerpage Side Effects Center, anemia report

SOURCE:

• Journal of Clinical Oncology 2002; 20. Advance Release.
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