Chemotherapy-induced anemia: the story of darbepoetin alfa

Abstract

Background:

Prior to the approval of the first erythropoiesis-stimulating agent (ESA) in the early 1990s, red blood cell transfusions were the primary means of treating severe chemotherapy-induced anemia (CIA), with little recourse for those with more mild forms of the condition. The introduction of the ESAs allowed treatment of mild-to-moderate CIA in patients with cancer. It has been a decade since darbepoetin alfa (DA), a second-generation ESA with a longer half-life, became available to patients with CIA.

Objective and methods:

We present a review of studies on DA in CIA, from its development through to the present day. Medline was searched for randomized clinical trials on DA. Additional trials and meta-analyses on ESAs were incorporated into this review when relevant.

Results:

The first publications on DA generally focused on optimal dosing, efficacy and tolerability. In these, it was shown that DA is an effective and well tolerated treatment option to achieve hematopoietic response, regardless of dosing interval. Subsequently, the focus shifted towards meta-analyses on survival data of all ESAs. These reported conflicting results regarding mortality and/or disease progression. However, guidelines for ESA use were updated and, when followed, these make ESAs a well tolerated and effective tool for managing CIA.

Conclusions:

As the past decade has broadened our knowledge on the benefits and risks of CIA management, continued high-quality studies will help to optimize treatment with ESAs in order to maximize quality of life for these patients. The limitation of a literature review of this nature is the complete reliance on previously published research and the availability of these studies using the methodology outlined above.

Key words::

• Chemotherapy-induced anemia
• Darbepoetin alfa
• Efficacy
• Erythropoiesis-stimulating agent
• Safety

Transparency

Declaration of funding

This study was funded by Amgen (Europe) GmbH.

Declaration of financial/other relationships

J.V. and J.G. have disclosed that they have received grant funding from Amgen; J.G. is also on Amgen’s Speakers’ Bureau. I.W. has no relevant financial relationships to disclose. S.E. has disclosed that he is a consultant for Amgen, owns stock in the company and is a former employee. M.H. has disclosed that he is a consultant for and on the Speakers’ Bureau of Vifor Pharma.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

Support for third-party writing assistance for this manuscript, furnished by Doreen Anders of Archimed Medical Communication AG, was provided by Amgen (Europe) GmbH.