Document Detail


American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer.
MedLine Citation:
PMID:  20975064     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To update American Society of Clinical Oncology/American Society of Hematology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer.
METHODS: An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched.
RESULTS: The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews.
RECOMMENDATIONS: For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels ≥ 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration-approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations.
Authors:
J Douglas Rizzo; Melissa Brouwers; Patricia Hurley; Jerome Seidenfeld; Murat O Arcasoy; Jerry L Spivak; Charles L Bennett; Julia Bohlius; Darren Evanchuk; Matthew J Goode; Ann A Jakubowski; David H Regan; Mark R Somerfield; ;
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Publication Detail:
Type:  Journal Article; Practice Guideline; Review     Date:  2010-10-25
Journal Detail:
Title:  Journal of clinical oncology : official journal of the American Society of Clinical Oncology     Volume:  28     ISSN:  1527-7755     ISO Abbreviation:  J. Clin. Oncol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-22     Completed Date:  2010-12-16     Revised Date:  2011-01-20    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4996-5010     Citation Subset:  IM    
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anemia / drug therapy,  etiology
Disease Progression
Erythropoietin / analogs & derivatives*,  therapeutic use
Erythropoietin, Recombinant / therapeutic use*
Hematinics / therapeutic use*
Humans
Neoplasms / drug therapy,  mortality,  physiopathology*
Chemical
Reg. No./Substance:
0/Erythropoietin, Recombinant; 0/Hematinics; 11096-26-7/Erythropoietin; 209810-58-2/darbepoetin alfa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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