NCCN Updates Cancer- and Treatment-Related Anemia Guidelines
ESAs are no longer recommended for the treatment of cancer-related anemia associated with solid tumors or hematologic malignancies other than myelodysplastic syndromes (MDS). ESA therapy is an option for patients receiving myelosuppressive chemotherapy who have symptoms of anemia and hemoglobin levels of less than 11 g/dL. ESA therapy should only be considered as an option for patients receiving myelosuppressive chemotherapy without symptoms of anemia if they have hemoglobin levels less than or equal to 10 g/dL and additional risk factors for the development of symptomatic anemia requiring transfusion. When ESAs are administered to patients with cancer receiving myelosuppressive chemotherapy, the drug dosage should be titrated to achieve hemoglobin levels in the range of 10 to less than 12 g/dL for the purpose of avoiding red blood cell transfusion. Use of ESAs in patients with cancer receiving myelosuppressive chemotherapy is limited to the period during chemotherapy and for a short period following chemotherapy, usually within 6 weeks following the end of such therapy. These changes reflect recent evidence indicating decreased survival in patients with cancer receiving ESA therapy and changes made to the product labels of these agents by the Food and Drug Administration (FDA).
In order to facilitate shared physician-patient decision-making for those patients with cancer at risk of anemia requiring transfusion who will undergo myelosuppressive chemotherapy, patient counseling regarding the risks and benefits of ESA therapy is recommended.
NCCN Clinical Practice Guidelines in Oncology(TM) are developed and updated through an evidence-based process with explicit review of the scientific evidence by multidisciplinary panels of expert physicians from NCCN Member Institutions. The most recent version of this and all the guidelines are available free of charge at www.nccn.org.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.
The NCCN Member Institutions are: City of Hope, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at The Ohio State University, Columbus, OH; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida, Tampa, FL; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.
For more information, visit www.nccn.org.
Posted: December 2007
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