ASCO and ASH Release Updated Guideline on the Use of Chemotherapy-Related Anemia Treatments in Cancer Patients
WASHINGTON, D.C. â€“ The American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) have released an updated joint guideline on the use of erythropoiesis-stimulating agents (ESAs), a class of drugs that stimulate the bone marrow to produce more red blood cells, to treat chemotherapy-related anemia.
â€œOne goal of these guidelines is to inform clinicians with the most up-to-date evidence from high-quality studies regarding the risks and benefits of ESAs in patients with cancer,â€ said J. Douglas Rizzo, MD, MS, co-chair of the guideline panel and Associate Professor of Medicine, Medical College of Wisconsin.
This updated guideline, originally published in 2002, was derived from systematic reviews and analysis of published clinical trials. It outlines the clotting risks of ESAs, makes recommendations on usage, and provides insights on disease progression and patient survival.
Specifically, the guideline:
- Declares epoetin and darbepoetin equally safe and effective.
- Recommends the use of ESAs as a treatment option for cancer patients who become anemic as a result of chemotherapy when their hemoglobin approaches or falls below 10 g/dL, as well as patients with low-risk myelodysplasia.
- Suggests that when using ESAs, hemoglobin can be raised to (or near) a concentration of 12 at which point the dosage should be titrated to maintain that level. Dose reductions are also recommended when hemoglobin rise exceeds 1 g/dL in any two-week period or when the hemoglobin level exceeds 11 g/dL.
- Recommends discontinuing use of ESAs beyond six to eight weeks if a patient has not responded to the drug.
- Recommends monitoring the iron levels of patients being treated with ESAs and providing supplements accordingly.
- Cautions against using ESAs for cancer patients not receiving chemotherapy since recent trials have shown increased thromboembolic risks and decreased survival under these circumstances.
â€œAs new data become available, it is important to update clinical practice guidelines to ensure that physicians make treatment decisions based upon the most up-to-date available evidence,â€ said Alan E. Lichtin, MD, guideline panel co-chair and Associate Professor of Medicine at the Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio. â€œHowever, new evidence can also reinforce previous recommendations, as it did in this guideline.â€
ESAs carry an increased risk for blood clots, strokes, and heart attacks in some patients under certain conditions, spurring the FDA to call for new drug warning labels this past March. Following the FDAâ€™s warning, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Decision this summer, outlining the specific conditions under which use of ESAs would be reimbursed for cancer patients.
â€œWe hope that these evidence-based recommendations will influence practice standards and result in better care for patients,â€ said Samuel Silver, MD, ASH Executive Committee Councillor, Chair, ASH Subcommittee on Reimbursement, and Professor of Internal Medicine at the University of Michigan in Ann Arbor, Michigan.
In developing the guideline update, panel members considered two meta-analyses that reviewed close to 60 randomized clinical trials. Additional evidence was considered when it was considered pertinent to each section of the updated guideline.
The guideline will be published ahead of print on the Web sites of Blood (bloodjournal.org), ASHâ€™s scientific journal, and ASCOâ€™s Journal of Clinical Oncology (jco.org) October 22 at 3:00 p.m. The guideline will be published in print in both journals December 1.
The American Society of Hematology (www.hematology.org) is the worldâ€™s largest professional society concerned with the causes and treatment of blood disorders. Its mission is to further the understanding, diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems, by promoting research, clinical care, education, training, and advocacy in hematology. Blood, the official journal of the American Society of Hematology, is the most cited peer-reviewed publication in the field. Blood is issued to Society members and other subscribers twice per month and is available in print and online at www.bloodjournal.org.
The American Society of Clinical Oncology (ASCO) is the worldâ€™s leading professional organization representing physicians of all oncology subspecialties who care for people with cancer. ASCOâ€™s nearly 25,000 members from the United States and abroad set the standard for patient care and lead the efforts to discover more effective cancer treatments, increase funding for clinical and translational research, and, ultimately, improve cancer care for the estimated 10 million people diagnosed with cancer worldwide each year. ASCO publishes the Journal of Clinical Oncology (JCO), the preeminent, peer-reviewed, medical journal on clinical cancer research, and produces People Living With Cancer (www.PLWC.org), a comprehensive consumer Web site providing oncologist-vetted cancer information to help patients and families make informed health-care decisions.