Originally published as JCO Early Release 10.1200/JCO.2007.14.3396 on October 22 2007

This Article Full Text Full Text (PDF) Publisher's Note Addendum Erratum (v26,p1192) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rizzo, J. D. Articles by Lichtin, A. E. Search for Related Content PubMed PubMed Citation Articles by Rizzo, J. D. Articles by Lichtin, A. E. Related Articles Related Correspondence Social Bookmarking                            What's this?

Use of Epoetin and Darbepoetin in Patients With Cancer: 2007 American Society of Clinical Oncology/American Society of Hematology Clinical Practice Guideline Update

J. Douglas Rizzo, Mark R. Somerfield, Karen L. Hagerty, Jerome Seidenfeld, Julia Bohlius, Charles L. Bennett, David F. Cella, Benjamin Djulbegovic, Matthew J. Goode, Ann A. Jakubowski, Mark U. Rarick, David H. Regan, Alan E. Lichtin

Medical College of Wisconsin, Milwaukee, WI; American Society of Clinical Oncology, Alexandria, VA; Blue Cross and Blue Shield Association; Northwestern University, Chicago; Evanston Northwestern Healthcare, Evanston, IL; University Hospital of Cologne, Cologne, Germany; H. Lee Moffitt Cancer Center, Tampa, FL; Patient Representative, Mesa, AZ; Memorial Sloan-Kettering Cancer Center, New York, NY; NW Kaiser Permanente, US Oncology, Portland, OR; and Cleveland Clinic Foundation, Cleveland, OH

Corresponding author: American Society of Clinical Oncology, 1900 Duke St, Suite 200, Alexandria, VA 22314; e-mail: guidelines{at}asco.org

Purpose To update the American Society of Clinical Oncology/American Society of Hematology (ASCO/ASH) recommendations for the use of epoetin. The guideline was expanded to address use of darbepoetin and thromboembolic risk associated with these agents.

Method An Update Committee ("Committee") reviewed and analyzed data published since 2002 through July 2007. MEDLINE and the Cochrane Collaboration Library databases were searched.

Recommendations For patients with chemotherapy-associated anemia, the Committee continues to recommend initiating an erythropoiesis-stimulating agent (ESA) as hemoglobin (Hb) approaches, or falls below, 10 g/dL, to increase Hb and decrease transfusions. ESA treatment continues to be recommended for patients with low-risk myelodysplasia for similar reasons. There is no evidence showing increased survival as a result of ESA treatment. Conclusive evidence is lacking that, absent clinical circumstances necessitating earlier treatment, initiating ESAs at Hb levels greater than 10 g/dL either spares more patients from transfusion or substantially improves their quality of life.

Starting doses and dose modifications based on response or lack thereof should follow the package insert. Continuing ESAs beyond 6 to 8 weeks in the absence of response, assuming appropriate dose increase has been attempted in nonresponders as per US Food and Drug Administration–approved labeling, does not seem to be beneficial, and ESA therapy should be discontinued. The Committee recommends monitoring iron stores and supplementing iron intake for ESA-treated patients. ESAs should be used cautiously with chemotherapy, or in clinical states, associated with elevated risk for thromboembolic complications. The Committee also cautions against ESA use for patients with cancer who are not receiving chemotherapy, since recent trials report increased thromboembolic risks and decreased survival under these circumstances.

published online ahead of print at www.jco.org on October 22, 2007.

Approved by the ASCO Board of Directors on August 15, 2007. Approved by the Executive Committee of ASH on August 14, 2007.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

This guideline was developed through a collaboration between the American Society of Clinical Oncology and the American Society of Hematology and has been published jointly by invitation and consent in both the Journal of Clinical Oncology and Blood. Copyright © 2007 American Society of Clinical Oncology and American Society of Hematology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology or the American Society of Hematology.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Reconsideration of American Society of Clinical Oncology/American Society of Hematology Erythropoiesis-Stimulating Agent Guidelines
  Nevin Murray and Richard Klasa
  JCO 2008 26: 3096-3097 [Full Text]
• Erythropoiesis-Stimulating Agents in Cancer
  Murat O. Arcasoy
  JCO 2008 26: 3097-3098 [Full Text]

This article has been cited by other articles:

				M. Aapro, H. Ludwig, C. Bokemeyer, K. MacDonald, P. Soubeyran, M. Turner, T. Albrecht, and I. Abraham Modeling of treatment response to erythropoiesis-stimulating agents as a function of center- and patient-related variables: results from the Anemia Cancer Treatment (ACT) study Ann. Onc., July 1, 2009; (2009) mdp063v1. [Abstract] [Full Text] [PDF]

				H. Ludwig, J. Crawford, A. Osterborg, J. Vansteenkiste, D. H. Henry, A. Fleishman, K. Bridges, and J. A. Glaspy Pooled Analysis of Individual Patient-Level Data From All Randomized, Double-Blind, Placebo-Controlled Trials of Darbepoetin Alfa in the Treatment of Patients With Chemotherapy-Induced Anemia J. Clin. Oncol., June 10, 2009; 27(17): 2838 - 2847. [Abstract] [Full Text] [PDF]

				I. Ray-Coquard, S. Dussart, C. Goillot, D. Mayeur, P. Debourdeau, H. Ghesquieres, T. Bachelot, A. Le Cesne, B. Anglaret, C. Agostini, et al. A risk model for severe anemia to select cancer patients for primary prophylaxis with epoetin {alpha}: a prospective randomized controlled trial of the ELYPSE study group Ann. Onc., June 1, 2009; 20(6): 1105 - 1112. [Abstract] [Full Text] [PDF]

				M. Tonelli, B. Hemmelgarn, T. Reiman, B. Manns, M. N. Reaume, A. Lloyd, N. Wiebe, and S. Klarenbach Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis Can. Med. Assoc. J., May 26, 2009; 180(11): E62 - E71. [Abstract] [Full Text] [PDF]

				A. A. Khorana, C. W. Francis, N. Blumberg, E. Culakova, M. A. Refaai, and G. H. Lyman Blood Transfusions, Thrombosis, and Mortality in Hospitalized Patients With Cancer Arch Intern Med, November 24, 2008; 168(21): 2377 - 2381. [Abstract] [Full Text] [PDF]

				K. Hagerty Continued Regulatory Actions Affecting the Use of Erythropoiesis-Stimulating Agents J. Oncol. Pract, November 1, 2008; 4(6): 267 - 270. [Full Text] [PDF]

				S. Thome Review: erythropoiesis-stimulating agents increase mortality and venous thromboembolism in cancer-associated anaemia Evid. Based Med., October 1, 2008; 13(5): 149 - 149. [Full Text] [PDF]

				G. H. Lyman ASCO Clinical Practice Guidelines: Past, Present and Future J. Oncol. Pract, September 1, 2008; 4(5): 236 - 237. [Full Text] [PDF]

				K. S. Courneya, L. W. Jones, C. J. Peddle, C. M. Sellar, T. Reiman, A. A. Joy, N. Chua, L. Tkachuk, and J. R. Mackey Effects of Aerobic Exercise Training in Anemic Cancer Patients Receiving Darbepoetin Alfa: A Randomized Controlled Trial Oncologist, September 1, 2008; 13(9): 1012 - 1020. [Abstract] [Full Text] [PDF]

				M. O. Arcasoy Erythropoiesis-Stimulating Agent Use in Cancer: Preclinical and Clinical Perspectives Clin. Cancer Res., August 1, 2008; 14(15): 4685 - 4690. [Abstract] [Full Text] [PDF]

				N. Murray and R. Klasa Reconsideration of American Society of Clinical Oncology/American Society of Hematology Erythropoiesis-Stimulating Agent Guidelines J. Clin. Oncol., June 20, 2008; 26(18): 3096 - 3097. [Full Text] [PDF]

				M. O. Arcasoy Erythropoiesis-Stimulating Agents in Cancer J. Clin. Oncol., June 20, 2008; 26(18): 3097 - 3098. [Full Text] [PDF]

				J. D. Rizzo, M. R. Somerfield, K. L. Hagerty, J. Seidenfeld, J. Bohlius, C. L. Bennett, D. F. Cella, B. Djulbegovic, M. J. Goode, A. A. Jakubowski, et al. In Reply J. Clin. Oncol., June 20, 2008; 26(18): 3098 - 3100. [Full Text] [PDF]

				D. Gordon, G. Nichols, A. Ben-Jacob, D. Tomita, T. Lillie, and C. Miller Treating Anemia of Cancer with Every-4-Week Darbepoetin Alfa: Final Efficacy and Safety Results from a Phase II, Randomized, Double-Blind, Placebo-Controlled Study Oncologist, June 1, 2008; 13(6): 715 - 724. [Abstract] [Full Text] [PDF]

				C. L. Bennett, S. M. Silver, B. Djulbegovic, A. T. Samaras, C. A. Blau, K. J. Gleason, S. E. Barnato, K. M. Elverman, D. M. Courtney, J. M. McKoy, et al. Venous Thromboembolism and Mortality Associated With Recombinant Erythropoietin and Darbepoetin Administration for the Treatment of Cancer-Associated Anemia JAMA, February 27, 2008; 299(8): 914 - 924. [Abstract] [Full Text] [PDF]