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

@article{citeulike:2261971, abstract = {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 Administrationapproved label, 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 thromoembolic 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. 10.1182/blood-2007-08-109488}, author = {Rizzo, Douglas J. and Somerfield, Mark R. and Hagerty, Karen L. and Seidenfeld, Jerome and Bohlius, Julia and Bennett, Charles L. and Cella, David F. and Djulbegovic, Benjamin and Goode, Matthew J. and Jakubowski, Ann A. and Rarick, Mark U. and Regan, David H. and Lichtin, Alan E. }, citeulike-article-id = {2261971}, doi = {http://dx.doi.org/10.1182/blood-2007-08-109488}, journal = {Blood}, keywords = {epoietin}, month = {January}, number = {1}, pages = {25--41}, posted-at = {2008-01-20 13:16:18}, priority = {2}, title = {Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update}, url = {http://dx.doi.org/10.1182/blood-2007-08-109488}, volume = {111}, year = {2008} }

TY - JOUR ID - citeulike:2261971 L3 - citeulike-article-id:2261971 TI - Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update JF - Blood VL - 111 IS - 1 SP - 25 EP - 41 N2 - 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 Administrationapproved label, 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 thromoembolic 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. 10.1182/blood-2007-08-109488 KW - epoietin AU - Rizzo, Douglas AU - Somerfield, Mark AU - Hagerty, Karen AU - Seidenfeld, Jerome AU - Bohlius, Julia AU - Bennett, Charles AU - Cella, David AU - Djulbegovic, Benjamin AU - Goode, Matthew AU - Jakubowski, Ann AU - Rarick, Mark AU - Regan, David AU - Lichtin, Alan PY - 2008/01/01/ UR - http://dx.doi.org/10.1182/blood-2007-08-109488 ER -