Use o f E poetin i n P atients W ith C ancer: E vidence-Based Clinical P ractice G uidelines o f t he A merican S ociety o f Clinical O ncology a nd t he A merican S ociety o f H ematology

Anemia resulting from cancer, or its treat- ment, is an important clinical problem increasingly treated with the recombinant hematopoietic growth factor erythropoietin. To address uncertainties regard- ing indications and efficacy, the American Society of Clinical Oncology and the American Society of Hema- tology developed an evidence-based clinical practice guideline for the use of epoetin in patients with cancer. The guideline panel found good evidence to recom- mend use of epoetin as a treatment option for patients with chemotherapy-associated anemia with a hemo- globin level less than 10 g/dL. Use of epoetin for pa- tients with less severe anemia (hemoglobin < 12 g/dL but never below 10 g/dL) should be determined by clinical circumstances. Good evidence from clinical trials supports the use of subcutaneous epoetin thrice weekly (150 U/kg tiw) for a minimum of 4 weeks. Less strong evidence supports an alternative weekly (40,000 U/wk) dosing regimen, based on common clinical prac- tice. With either administration schedule, dose escala- tion should be considered for those not responding to the initial dose. In the absence of response, continuing epoetin beyond 6 to 8 weeks does not appear to be beneficial. Epoetin should be titrated once the hemoglo- bin concentration reaches 12 g/dL. Evidence from one randomized controlled trial supports use of epoetin for patients with anemia associated with low-risk myelodys- plasia not receiving chemotherapy; however, there are no published high-quality studies to support its use for anemia in other hematologic malignancies in the absence of chemotherapy. Therefore, for anemic patients with hematologic malignancies, it is recommended that physi- cians initiate conventional therapy and observe hemato- logic response before considering use of epoetin. J Clin Oncol 20:4083-4107. © 2002 by American Soci- ety of Clinical Oncology and American Society of Hema- tology.