The American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) have released an updated joint guideline on the use of erythropoiesis-stimulating agents (ESAs), a class of drugs that stimulate the bone marrow to produce more red blood cells, to treat chemotherapy-related anemia.
"One goal of these guidelines is to inform clinicians with the most up-to-date evidence from high-quality studies regarding the risks and benefits of ESAs in patients with cancer," said J. Douglas Rizzo, MD, MD, cochair of the guideline panel and associate professor of medicine, Medical College of Wisconsin.This updated guideline, originally published in 2002, was derived from systematic reviews and analysis of published clinical trials. It outlines the clotting risks of ESAs, makes recommendations on usage, and provides insights on disease progression and patient survival.
Specifically, the guideline:
• Declares epoetin (Epogen, Procrit) and darbepoetin (Aranesp) equally safe and effective.
• Recommends the use of ESAs as a treatment option for cancer patients who become anemic as a result of chemotherapy when their hemoglobin approaches or falls below 10 g/dL, as well as for patients with low-risk myelodysplasia.
• Suggests that when using ESAs, hemoglobin can be raised to (or near) a concentration of 12 g/dL at which point the dosage should be titrated to maintain that level. Dose reductions are also recommended when hemoglobin rise exceeds 1 g/dL in any 2-week period or when the hemoglobin level exceeds 11 g/dL.