Originally published as JCO Early Release 10.1200/JCO.2002.07.177 on August 29 2002
Journal of Clinical Oncology, Vol 20, Issue 19
(October), 2002: 4083-4107
© 2002 American Society for Clinical Oncology
Use of Epoetin in Patients With Cancer: Evidence-Based Clinical Practice Guidelines of the American Society of Clinical Oncology and the American Society of Hematology
By J. Douglas Rizzo,
Alan E. Lichtin,
Steven H. Woolf,
Jerome Seidenfeld,
Charles L. Bennett,
David Cella,
Benjamin Djulbegovic,
Matthew J. Goode,
Ann A. Jakubowski,
Stephanie J. Lee,
Carole B. Miller,
Mark U. Rarick,
David H. Regan,
George P. Browman,
Michael S. Gordon
From the Medical College of Wisconsin, Milwaukee, WI; Cleveland Clinic Foundation, Cleveland, OH; Virginia Commonwealth University, Richmond, VA; Blue Cross and Blue Shield Association Technology Evaluation Center and Veterans Affairs Chicago Health Care System, Chicago; Evanston Northwestern Healthcare, Evanston, IL; H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL; patient representative, Mesa; University of Arizona Health Sciences Center, Phoenix, AZ; Memorial Sloan-Kettering Cancer Center, New York, NY; Dana-Farber Cancer Institute, Boston, MA; Saint Agnes Hospital, Baltimore, MD; NW Kaiser Permanente and Northwest Cancer Specialists, Portland, OR; and Hamilton Regional Cancer Center, Hamilton, Ontario, Canada.
Address reprint requests to American Society of Clinical Oncology, Health Services Research Department, 1900 Duke St, Suite 200, Alexandria, VA 22314; email: guidelines{at}asco.org
ABSTRACT: Anemia resulting from cancer, or its treatment, is an important clinical problem increasingly treated with the recombinant hematopoietic growth factor erythropoietin. To address uncertainties regarding indications and efficacy, the American Society of Clinical Oncology and the American Society of Hematology developed an evidence-based clinical practice guideline for the use of epoetin in patients with cancer. The guideline panel found good evidence to recommend use of epoetin as a treatment option for patients with chemotherapy-associated anemia with a hemoglobin level less than 10 g/dL. Use of epoetin for patients with less severe anemia (hemoglobin < 12 g/dL but never below 10 g/dL) should be determined by clinical circumstances. Good evidence from clinical trials supports the use of subcutaneous epoetin thrice weekly (150 U/kg tiw) for a minimum of 4 weeks. Less strong evidence supports an alternative weekly (40,000 U/wk) dosing regimen, based on common clinical practice. With either administration schedule, dose escalation should be considered for those not responding to the initial dose. In the absence of response, continuing epoetin beyond 6 to 8 weeks does not appear to be beneficial. Epoetin should be titrated once the hemoglobin concentration reaches 12 g/dL. Evidence from one randomized controlled trial supports use of epoetin for patients with anemia associated with low-risk myelodysplasia not receiving chemotherapy; however, there are no published high-quality studies to support its use for anemia in other hematologic malignancies in the absence of chemotherapy. Therefore, for anemic patients with hematologic malignancies, it is recommended that physicians initiate conventional therapy and observe hematologic response before considering use of epoetin.
Adopted May 17, 2002, by the American Society of Clinical Oncology.
Adopted April 18, 2002, by the American Society of Hematology.
This article was published ahead of print at www.jco.org.
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M. L de Lemos
Rationing costly treatments: can it be fair?
Journal of Oncology Pharmacy Practice,
September 1, 2004;
10(3):
141 - 144.
[Abstract]
[PDF]
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L. M. Wagner, C. A. Billups, W. L. Furman, B. N. Rao, and V. M. Santana
Combined Use of Erythropoietin and Granulocyte Colony-Stimulating Factor Does Not Decrease Blood Transfusion Requirements During Induction Therapy for High-Risk Neuroblastoma: A Randomized Controlled Trial
J. Clin. Oncol.,
May 15, 2004;
22(10):
1886 - 1893.
[Abstract]
[Full Text]
[PDF]
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M. Auerbach, H. Ballard, J. R. Trout, M. McIlwain, A. Ackerman, H. Bahrain, S. Balan, L. Barker, and J. Rana
Intravenous Iron Optimizes the Response to Recombinant Human Erythropoietin in Cancer Patients With Chemotherapy-Related Anemia: A Multicenter, Open-Label, Randomized Trial
J. Clin. Oncol.,
April 1, 2004;
22(7):
1301 - 1307.
[Abstract]
[Full Text]
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J. M Kolesar, B. A Duren, and B. G Baranski
Retrospective evaluation of response to epoetin alfa in patients with hematologic disorders
Journal of Oncology Pharmacy Practice,
March 1, 2004;
10(1):
1 - 6.
[Abstract]
[PDF]
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J. Patton, M. Kuzur, W. Liggett, F. Miranda, H. Varsos, and L. Porter
Epoetin Alfa 60,000 U Once Weekly Followed by 120,000 U Every 3 Weeks Increases and Maintains Hemoglobin Levels in Anemic Cancer Patients Undergoing Chemotherapy
Oncologist,
February 1, 2004;
9(1):
90 - 96.
[Abstract]
[Full Text]
[PDF]
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D. H. Henry
The Evolving Role of Epoetin Alfa in Cancer Therapy
Oncologist,
February 1, 2004;
9(1):
97 - 107.
[Abstract]
[Full Text]
[PDF]
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D. G. Pfister, D. H. Johnson, C. G. Azzoli, W. Sause, T. J. Smith, S. Baker Jr, J. Olak, D. Stover, J. R. Strawn, A. T. Turrisi, et al.
American Society of Clinical Oncology Treatment of Unresectable Non-Small-Cell Lung Cancer Guideline: Update 2003
J. Clin. Oncol.,
January 15, 2004;
22(2):
330 - 353.
[Full Text]
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C. A. Thompson, T. D. Shanafelt, and C. L. Loprinzi
Andropause: Symptom Management for Prostate Cancer Patients Treated With Hormonal Ablation
Oncologist,
October 1, 2003;
8(5):
474 - 487.
[Abstract]
[Full Text]
[PDF]
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A. R. Nissenson, L. T. Goodnough, and R. W. Dubois
Anemia: Not Just an Innocent Bystander?
Arch Intern Med,
June 23, 2003;
163(12):
1400 - 1404.
[Full Text]
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A. Bottomley, R. Thomas, K. Van Steen, H. Flechtner, and A. de Graeff
Guidelines for the Use of Epoetin: Have Quality-of-Life Benefits Been Proven?
J. Clin. Oncol.,
June 1, 2003;
21(11):
2223 - 2223.
[Full Text]
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H. W. Daniell
Androgen Augmentation of Epoetin
J. Clin. Oncol.,
June 1, 2003;
21(11):
2224 - 2224.
[Full Text]
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T. Ng
Whether an Increase in Hemoglobin Above 12 g/dL Is of Clinical Benefit
J. Clin. Oncol.,
June 1, 2003;
21(11):
2223 - 2224.
[Full Text]
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J. D. Rizzo, D. Cella, and J. Seidenfeld
In Reply:
J. Clin. Oncol.,
June 1, 2003;
21(11):
2224 - 2225.
[Full Text]
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J. F. Vansteenkiste and A. B. Colowick
RESPONSE: Re: Double-Blind, Placebo-Controlled, Randomized Phase III Trial of Darbepoetin Alfa in Lung Cancer Patients Receiving Chemotherapy
J Natl Cancer Inst,
May 21, 2003;
95(10):
762 - 763.
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