The value of erythropoietin therapy in cancer patients

Fatigue is an extremely common symptom in cancer patients, often producing a deleterious effect on quality of life. It is most commonly the consequence of anemia, which results from the cancer itself or therapy. Considerable interest exists as to whether the use of recombinant human erythropoietin (rHuEPO) or a newer analog, darbepoetin alfa, is able to correct or prevent anemia in cancer patients, reduce or abolish transfusion requirements, and improve quality of life. Studies have explored the use of erythropoietin in several settings, including patients receiving (or not) cytostatic therapy. Fifty to sixty percent of patients respond to erythropoietin but the expense of this drug prompts concern about its cost effectiveness and as a result, consideration of how best to target its use. The prolonged duration of action of darbepoetin alfa allows less frequent administration (typically once a week) compared with rHuEPO, but the optimal dose and regimen are less well defined. However, it is clear that in randomized placebo-controlled trials and in large open-label community based programs of cancer patients rHuEPO is clinically effective in reducing transfusion requirements and preserving quality of life, whether or not anticancer treatments are being used. The major unresolved dilemma is whether rHuEPO is a cost-effective replacement of transfusion services, a question that has not been well studied in cancer patients. © 2005 Adis Data Information BV. All rights reserved.