Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update

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

doi:10.1182/blood-2007-08-109488

Cited by 144 publications

(68 citation statements)

References 33 publications

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“…The EORTC also still endorses the use of ESA for an improvement of quality of life (QoL) [29,31], whereas the ASCO and ASH do not. In the ASCO/ASH guideline version of 2008, evidence ‘that initiating ESAs at Hb levels > 10 g/dl either spares more patients from transfusion or substantially improves their quality of life' was considered not conclusive [26,41]. The most recent version still doubts the effect size for QoL change to be clinically meaningful and recommends ‘that the goal of ESA use should be to avoid transfusions without specific consideration of improvement in QoL as a target outcome' [28,42].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cancer-Associated Anaemia: Results from a Two-Day Cross-Sectional Survey in Germany

Schmitz

2013

Oncol Res Treat

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Background: The aim was to re-evaluate the current prevalence and management of cancer-associated anaemia as defined by the World Health Organisation (WHO) and related risk factors. Patients and Methods: This was a prospective, 2-day web-based cross-sectional survey in cancer patients with non-myeloid malignancies in German outpatient clinics. Results: 89 centres collected data from 3,867 patients, of whom 74% received active cancer therapy. The median age was 65 years (range 19-99 years) and almost two-thirds were women; 68% of the patients had solid tumours (breast 34%, colorectal 17%, lung 8%), with 56% of them being metastatic; 73% had a WHO performance score of ≤ 1. The mean haemoglobin level was 12.0 ± 1.7 g/dl (± standard deviation; range 4.3-17.8 g/dl); the prevalence of levels below 12.0 g/dl was 49%. Two-thirds of these patients were not treated for anaemia; one-third received erythropoiesis-stimulating agents (12.6%), iron therapy (8.1%), transfusions (7.5%) or combinations thereof (8.0%) during the 4 weeks before evaluation. Chemotherapy, female sex, age and poor performance status were identified as significant anaemia-associated factors. Conclusions: The prevalence of untreated anaemia and the decreased performance status of cancer patients in Germany have hardly changed since the European Cancer Anaemia Survey (ECAS) in 2001. The treatment practice may not only be driven by guidelines and does not yet reflect new concepts of anaemia management.

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Section: Discussionmentioning

confidence: 99%

Treatment of Cancer-Associated Anaemia: Results from a Two-Day Cross-Sectional Survey in Germany

Schmitz

2013

Oncol Res Treat

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“…ESA labels recommend evaluation of iron status before and during treatment with ESAs and recommend iron supplementation for correction of iron deficiency (serum ferritin levels <100 ng mL 21 or serum transferrin saturation [Tsat] < 20%) [1,2,13]. The American Society of Clinical Oncology/ American Society of Hematology (ASCO/ASH) guidelines also recommend iron supplementation in cancer patients with low iron stores receiving ESA therapy [1,2,[13][14][15]. In addition, the National Comprehensive Cancer Network (NCCN) guidelines now recommend intravenous (IV) iron supplementation with low molecular weight (LMW) iron dextran for CIA patients with functional iron deficiency [16].…”

Section: Introductionmentioning

confidence: 99%

Darbepoetin alfa 300 or 500 μg once every 3 weeks with or without intravenous Iron in patients with chemotherapy‐induced anemia

Auerbach

Silberstein

Webb³

et al. 2010

American J Hematol

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This study evaluated efficacy and safety of darbepoetin alfa administered every 3 weeks (Q3W) at fixed doses of 300 or 500 μg with or without intravenous (IV) iron in treating anemia in patients receiving multicycle chemotherapy. This Phase 2, double‐blind, 2 × 2 factorial study randomized patients to one of four treatment arms; darbepoetin alfa 300 μg (n = 62), darbepoetin alfa 300 μg plus IV iron (n = 60), darbepoetin alfa 500 μg (n = 60), or darbepoetin alfa 500 μg plus IV iron (n = 60). Patients had nonmyeloid malignancies, hemoglobin levels ≤10 g dL−1, and no iron deficiency. Primary endpoint was achievement of target hemoglobin (≥11 g dL−1). Secondary endpoints included incidence of transfusions and change in Functional Assessment of Cancer Therapy Fatigue (FACT‐F) score from baseline to end of study. Safety was evaluated by incidence of adverse events. No evidence of a statistically significant interaction between darbepoetin alfa dose received and IV iron usage was observed, therefore, results are provided separately comparing darbepoetin alfa doses and comparing IV iron usage groups. Similar proportions of patients receiving darbepoetin alfa 300 or 500 μg achieved target hemoglobin (75 and 78%, respectively); Kaplan–Meier median time to target hemoglobin was 10 and 8 weeks, respectively. More patients receiving IV iron (82%) than not receiving IV iron (72%) achieved hemoglobin target. Adverse events profiles were similar for darbepoetin alfa treatment groups. Transient anaphylactoid reactions were reported in two patients receiving IV iron. Darbepoetin alfa at 300 μg Q3W and 500 μg Q3W showed similar benefit, while added IV iron improved treatment response in these patients. Am. J. Hematol., 2010. © 2010 Wiley‐Liss, Inc.

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“…Since the high doses of EPO used in anemic cancer patients have been linked to increased spread of cancer, increased thrombophlebitic complications and increased mortality [82,83,84], there is growing interest in reducing the EPO doses by using more IV iron in these conditions. There is now a black box warning in cancer patients.…”

Section: Iron Deficiency and Thrombocytosismentioning

confidence: 99%

The Anemia of Heart Failure

Silverberg¹,

Wexler²,

Palazzuoli³

et al. 2009

Acta Haematol

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Anemia is common in congestive heart failure (CHF) and is associated with an increased mortality and morbidity. The most likely causes of anemia are chronic kidney disease (CKD) and excessive cytokine production, both of which can cause depression of erythropoietin (EPO) production and bone marrow activity. The cytokines also induce iron deficiency by both reducing gastrointestinal iron absorption and iron release from iron stores located in the macrophages and hepatocytes. Iron deficiency can cause thrombocytosis which might also contribute to cardiovascular complications in both CHF and CKD and is partially reversible with iron treatment. Thus attempts to control this anemia will have to consider both the use of erythropoiesis-stimulating agents (ESA), such as EPO, as well as oral and, probably more importantly, intravenous (IV) iron. The many studies on anemia in CHF patients treated with ESA and oral or IV iron, and even with IV iron without ESA have up to now shown a quite consistent positive effect on hospitalization, fatigue, shortness of breath, quality of life, exercise capacity, and β-natriuretic peptide reduction, in the absence of increased cardiovascular damage related to the therapy. Adequately powered long-term placebo-controlled studies of ESA and/or IV iron are currently being carried out and their results are eagerly awaited.

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Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update

Cited by 144 publications

References 33 publications

Treatment of Cancer-Associated Anaemia: Results from a Two-Day Cross-Sectional Survey in Germany

Treatment of Cancer-Associated Anaemia: Results from a Two-Day Cross-Sectional Survey in Germany

Darbepoetin alfa 300 or 500 μg once every 3 weeks with or without intravenous Iron in patients with chemotherapy‐induced anemia

The Anemia of Heart Failure

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