Abstract
Anemia, already common in cancer patients, is often exacerbated by chemotherapy. Cancer patients who are anemic have been shown to have a blunted response for production of endogenous erythropoietin growth factor. This anemia can be corrected with exogenous erythropoietin growth factors, of which three available are worldwide: epoetin alfa, epoetin beta, and darbepoetin alfa. Collectively, these drugs are known as erythropoiesis-stimulating agents (ESAS). Orders for ESAS have been used not only to reverse anemia so as to avoid blood transfusion, but also to improve quality of life. Guidelines have been developed for initiation, dosage titration, and termination of these agents. Since the late 1990s, trials have been conducted using ESAS in unapproved dosing regimens or to reach hemoglobin levels outside of approved guidelines, raising several safety concerns. The present article explores the risks and benefits of ESAS.
Highlights
Anemia is a common finding in cancer patients and can be a result of treatment or of underlying disease 1
The first randomized trial in cancer patients demonstrated that recombinant human erythropoietin is effective for treating anemia in cancer patients on chemotherapy 4
Efficacy results showed a reduction in transfusions by approximately 50% during the second and third months of chemotherapy in the patients treated with epoetin alfa
Summary
Anemia is a common finding in cancer patients and can be a result of treatment or of underlying disease 1. Recombinant human erythropoietin was first used clinically in renal dialysis patients in the 1980s, at which time it was shown to correct anemia in endstage renal disease 3. Those findings led to a recognition that anemia in patients with malignancy might be able to be reversed, leading to an improvement in hemoglobin level, rate of transfusion, and quality of life (QOL). To broaden the indications for use, trials were conducted in patients not on active chemotherapy treatment Neither of those strategies worked, and confusion regarding the safety of this class of drugs instead resulted. Demonstrated risks of ESAs include risk of thromboembolic disease, negative impact on survival, and risk of tumour proliferation
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