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Use Anemia Drugs for Cancer Patients With Caution, Experts Say

TUESDAY, Oct. 26 (HealthDay News) -- Physicians need to use caution when giving a class of drugs called erythropoiesis-stimulating agents (ESAs) to cancer patients who have anemia caused by chemotherapy, according to new medical guidelines.

And with rare exceptions, ESAs should not be given to cancer patients who are not receiving chemotherapy, according to joint guidelines issued by the American Society of Hematology and the American Society of Clinical Oncology.

ESAs (marketed as Procrit, Epogen and Aranesp) stimulate the bone marrow to produce more red blood cells but are associated with shorter survival and increased risk of blood clots and tumor progression, the guidelines noted.

However, ESAs reduce the need for red blood cell transfusions, which carry a risk of serious infection and adverse reactions in the immune system.

The guidelines offer specific recommendations on the use of ESAs. Among them:

  • ESAs should not be given to cancer patients who are not receiving chemotherapy, except for those with myelodysplastic syndrome (MDS).
  • Doctors should discuss individual risks and benefits of ESAs and blood transfusion with patients before therapy. This shared decision-making is critical.

"This updated guideline offers clinicians the latest synthesis of the medical evidence surrounding the use of ESAs in patients with cancer, including appropriate cautions where evidence is lacking or where risks may outweigh the use of ESAs," guideline panel co-chair Dr. J. Douglas Rizzo, professor of medicine at the Medical College of Wisconsin, said in an American Society of Hematology news release.

"These guidelines touch on almost all aspects of the use of ESAs in patients with cancer and MDS, as well as secondary issues, such as the role of iron supplementation," Dr. Samuel Silver, a member of the ASH Committee on Practice and a professor of internal medicine at the University of Michigan, added in the news release.

The updated guidelines appear online Oct. 25 ahead of print in the Nov. 18 issue of Blood and the Nov. 20 issue of the Journal of Clinical Oncology.

More information

The U.S. Food and Drug Administration has more about ESAs.

-- Robert Preidt

SOURCE: American Society of Hematology, news release, Oct. 25, 2010

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