Doctors need to exhibit extreme caution before prescribing a class of anemia drugs known as erythropoeisis-stimulating agents (ESAs) to cancer patients, according to an updated guideline endorsed by the American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO).
Anemia is a fairly common side effect of chemotherapy. As a result, ESAs such as Procrit, Epogen and Arenesp are frequently prescribed to stimulate the production of additional red blood cells. While such medications are typically preferred over the alternative of blood transfusions, experts warn that such drugs have been linked to reduced survival times of cancer patients. An increased risk of internal blood clotting has also been noted.
According to the new guidelines, physicians are urged not to recommend ESAs for any cancer patient who is currently not undergoing chemotherapy (with the exception of patients with myelodysplastic syndrome). For patients dealing with chemotherapy, new guidelines suggest physicians should discuss the many benefits and risks of ESAs directly with each patient. When discussing these risks, it is also important to discuss the alternative of blood transfusions and how this alternative may affect quality of life.
These updated recommendations are based on the analysis of a variety of information sources. These sources include analysis of published clinical trials, various medical literature and reviews of individual patient data.
Further recommendations for dosage levels, thresholds for initiation and modification of ESAs are also detailed in the new guidelines. According to ASH member Samuel Silver, MD, “These are issues that confront practicing hematologists and oncologists on a daily basis, and we hope that these evidence-based recommendations will influence practice standards and result in better care for patients.”
Complete guidelines will also be published in the November 18th issue of Blood and the November 20th issue of the Journal of Clinical Oncology.