Management of Cancer-Associated Anemia With Erythropoiesis-Stimulating Agents

Document Overview

Document Title

Management of Cancer-Associated Anemia With Erythropoiesis-Stimulating Agents

Authoring Society

American Society of Clinical Oncology

Document Publication Date

Jun 4, 2019

Page Last Reviewed/Updated

May 5, 2026

Document Type

Guideline

Country of Publication

United States

Full Text Freely Available

Yes

Full Text Guideline

ascopubs.org/doi/full/10.1200/JOP.19.00111

Source Citation

DOI: 10.1200/JOP.19.00111 Journal of Oncology Practice 15, no. 7 (July 01, 2019) 399-402.

Supplemental Implementation Resources

• Quick-Reference Guide
• Quick-Reference Guide
• Slide Set
• Visual Abstract
• Visual Abstract
• Quick-Reference Guide
• Podcast
• Patient Information
• Patient Information
• Patient Information

Document Scope, Criteria, and Use Cases

Document Objectives

ASCO and the American Society of Hematology first published a joint evidence-based clinical practice guideline for the use of ESAs in adults with cancer and anemia in 2002, with updates in 2007 and 2010. Since the 2010 update, additional information has emerged about the safety and efficacy of ESAs in patients with metastatic breast cancer and about the role of iron in conjunction with ESAs. Treatment options have also expanded with the 2018 FDA approval of a biosimilar of epoetin alfa, warranting a guideline update.

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D000740 - Anemia

D000740 - Anemia

Keywords

Cancer-Associated Anemia, ESAs, anemia, erythropoiesis-stimulating agents

Target Patient Population

Adults with cancer and anemia.

Target Provider Population

Oncologists, hematologists, oncology nurses, oncology pharmacists, other health care professionals who care for patients with cancer

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

1. To reduce the need for RBC transfusions, should ESAs be offered to patients who have chemotherapy-associated anemia?
2. To reduce the need for RBC transfusions, should ESAs be offered to patients with anemia who are not receiving concurrent myelosuppressive chemotherapy?
3. What special considerations apply to adult patients with nonmyeloid hematologic malignancies who are receiving concurrent myelosuppressive chemotherapy?
4. What examinations and diagnostic tests should be performed before making a decision about using an ESA, to identify patients who are likely to benefit from an ESA?
5. Among adult patients who receive an ESA for chemotherapy-associated anemia, do darbepoetin, epoetin beta and alfa originator, and currently available biosimilars of epoetin alfa differ with respect to safety or efficacy?
6. Do ESAs increase the risk of thromboembolism?
7. Among adult patients who will receive an ESA for chemotherapy-associated anemia, what are recommendations for ESA dosing and dose modifications?
8. Among adult patients who will receive an ESA for chemotherapy-associated anemia, what is the recommended target hemoglobin (Hb) level?
9. Among adult patients with chemotherapy-associated anemia who do not respond to ESA therapy (< 1 to 2 g/dL increase in Hb or no decrease in transfusion requirements), does continuation of ESA therapy beyond 6 to 8 weeks provide a benefit?
10. Among adult patients with chemotherapy-associated anemia, does iron supplementation concurrent with an ESA reduce transfusion requirements?

Supplemental Methodology Resource

Data Supplement

Number of Source Documents

99

Includes peer/external review process?

Yes

Includes public comment process?

Yes

Methodologist involvement?

Yes

Patient involvement?

Yes

Includes multi-disciplinary group?

Yes

Includes systematic review?

Yes

Grades quality of strength of evidence?

Yes

Grades quality of strength of recommendation?

Yes

Discloses funding source?

Yes

Discloses conflicts of interest?

Yes

Includes benefits/harms analysis with recommendations?

Yes