Epoetin alfa in cancer patients: Evidence-based guidelines

Anemia is a common cause of cancer-related fatigue. A systematic review of the literature was performed to establish guidelines on the use of epoetin alfa for the treatment of anemia. The evidence in support of these guidelin es was selected, reviewed, and summarized by the members of the Canadian Ca ncer and Anemia Guidelines Development Group. The effects of epoetin a fa o n quality of life (QOL) in patients with cancer were examined in 5 randomiz ed, placebo-controlled trials and 2 large, open-label, nonrandomized, commu nity-based studies. The effects of epoetin a fa on red blood cell transfusi on requirements were examined in 19 randomized controlled trials (RCTs) wit h 21 comparisons. All trials compared epoetin a fa to a suitable control gr oup, examined specified outcome measures that could be analyzed, and studie d patients with cancer who were receiving chemotherapy. Trials involving pa tients with hematologic malignancies originating in the bone marrow were ex cluded. Outcome measures included 1) quality of life (QOL) (as measured by scales including the Linear Analogue Self-Assessment [LASA] and the Functio nal Assessment of Cancer Therapy [FACT] subscales), and 2) transfusion requ irements (as measured by the proportion of patients requiring transfusion a nd amount of transfusion). The analysis confirmed that epoetin alfa produce d statistically significant and clinically relevant improvements in QOL in patients with cancel: The overall relative risk ratio for transfusion among patients receiving epoetin aura was calculated to be 0.60 (95% Cl, 0.53-0. 69; P < 0.00001), representing a 40% reduction in the proportion of patient s requiring transfusion. These results support recommendations for the use of epoetin alfa in patients with cancer-related anemia. J Pain Symptom Mana ge 2001;22:954-965 (C) U.S. Cancer Pain Relief Committee, 2001.