Hemoglobin levels that trigger erythropoiesis-stimulating agent treatment decisions for cancer-associated anemia – examination of practice in Germany

ABSTRACT

Objective: Given the safety concerns regarding off-label use of erythropoiesis-stimulating agents (ESAs) in the treatment of cancer-associated anemia, data from the German Cancer Anemia Registry (CAR) were analyzed to examine whether current practice in Germany adheres to treatment guidelines.

Research design and methods: CAR was a web-based registry gathering patient data for 12 weeks following anemia diagnosis or until the primary treatment objective was achieved.

Results: Of over 2000 patients surveyed, 783 were treated with ESAs. Treatment was primarily aimed at improvement of quality of life (37.3%), hemoglobin correction (32.7%), and prevention of transfusions (24.4%). The average hemoglobin level triggering ESA treatment was 9.7 g/dL (6.0 mmol/L), however, starting levels varied with cancer type. For 67.8% of patients, transfusions could be avoided. ESA treatment was stopped at 11.2 g/dL (7.0 mmol/L) and maximum hemoglobin levels during the study averaged 11.8 g/dL (7.3 mmol/L). In 4.8% of the women and 6.0% of the men, maximum hemoglobin levels were >14 g/dL (8.7 mmol/L); in 15.6% and 9.1%, respectively, levels were between 13 and 14 g/dL. The median hemoglobin level triggering transfusion was 8.3 g/dL (5.2 mmol/L), irrespective of the malignant disease.

Conclusion: Current use of ESAs for the treatment of cancer-associated anemia in Germany appears to be in good compliance with treatment guidelines. Similar results obtained from other studies in Europe and the US indicate this to be true beyond Germany.

Key words: :

• Cancer-associated anemia
• Erythropoiesis-stimulating agent
• Hemoglobin
• In-use study
• Registry

Acknowledgements

Declaration of interest: This study was supported by Amgen GmbH, Germany. TS has served as a consultant and as a speaker at meetings for Amgen. UT is employed by a CRO of which Amgen is a client. None of the other authors have any conflicts of interest that are relevant to the contents of this article.

The authors thank all participating investigators who contributed data to this study.