Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy

Anaemia is defined as a haemoglobin concentration, red cell count, or packed cell volume below normal levels. The World Health Organization defines anaemia as a haemoglobin concentration of less than 120 g/litre in women and less than 130 g/litre in men. Erythropoiesis, the production of red blood cells, occurs in the bone marrow, needs iron and is stimulated by the hormone erythropoietin, which is produced in the kidneys. Cancer treatment can suppress the production of red blood cells in the bone marrow. Once cytotoxic chemotherapy stops, haemoglobin can return to pre‑treatment concentrations.

Anaemia can compromise the effect of treatment for cancer, reduce survival and cause symptoms that affect quality of life. Mild‑to‑moderate anaemia can cause headache, palpitations, tachycardia and shortness of breath. Chronic anaemia can damage organs. Severe fatigue is the most common symptom, and can lead to an inability to perform everyday tasks.

Approximately 60% of people with solid tumours who have chemotherapy develop anaemia, with a haemoglobin concentration of less than 110 g/litre. The incidence of anaemia is highest in people with lung cancer (71%) and gynaecological cancer (65%) because these cancers currently involve treatment with platinum‑based chemotherapy. The proportion of people with solid tumours who need a red blood cell transfusion because of their anaemia varies from 47% to 100% depending on the stage of the cancer, the cumulative dose of platinum chemotherapy, the person's age and pre‑treatment haemoglobin concentration. For haematological cancers, about 70% of people with lymphoma have anaemia after 3 to 4 cycles of chemotherapy.

Anaemia associated with cancer treatment is managed by adjusting the cancer treatment regimen, giving iron supplements and, if anaemia is severe, transfusing red blood cells. Problems related to blood transfusions may potentially include a limited supply of blood, iron overload, immune injury, and viral and bacterial infections. NICE's technology appraisal guidance TA142 on epoetin alfa, epoetin beta and darbepoetin alfa for cancer treatment‑induced anaemia recommends erythropoietin analogues plus intravenous iron as an option for managing cancer treatment‑induced anaemia in women having platinum‑based chemotherapy for ovarian cancer and who have symptoms associated with anaemia and a haemoglobin concentration of 80 g/litre or lower. Clinicians may also consider erythropoietin analogues for people who cannot have blood transfusions and who have profound cancer treatment‑related anaemia that is likely to affect survival.