ASCO/ASH update guidelines on use of ESAs for cancer-induced anemia

New guidelines advise caution advised when prescribing epoetin and darbepoetin


An updated clinical practice guideline issued by the American Society of Clinical Oncology and the American Society of Hematology provides detailed recommendations on use of the erythropoiesis-stimulating agents (ESAs) epoetin and darbepoetin in adults with cancer-induced anemia.
 
The guideline, which updates the 2007 guideline, states that these agents should be avoided in patients who are not receiving concurrent chemotherapy, except for those with lower-risk myelodysplastic syndromes.
 
For patients receiving myelosuppressive chemotherapy who have hemoglobin levels less than 10 g/dL, the guideline advises that clinicians discuss the potential risks (eg, thromboembolism, shorter survival) and benefits (eg, reduced transfusions) of ESAs and state that shared decision-making on management of anemia is essential. Other possible causes of anemia should be considered before initiating therapy.
 
When used, the ESAs should be started at the lowest possible dose and should increase the hemoglobin level to the lowest level possible to avoid transfusions. Special precaution is advised when these agents are given to patients at increased risk for thromboembolism.
 
The guideline was published online October 25 and will appear in the November 18 issue of Blood and the November 20 issue of the Journal of Clinical Oncology.