New guideline from ASH and ASCO recommends caution regarding ESA use in cancer patients

An updated joint guideline by the American Society of Hematology (ASH) and the American Society of Clinical Oncology (ASCO) advises physicians about the appropriate use of erythropoiesis-stimulating agents (ESAs), a class of drugs that stimulate the bone marrow to produce more red blood cells, to treat cancer patients with chemotherapy-induced anemia.

While the guideline cautions that ESAs are associated with shorter survival and increased risk of thromboembolism - blood clots - and tumor progression, it also recognizes their major benefit of reducing the need for red blood cell transfusions, which can potentially cause serious infections and adverse reactions in the immune system.

ESAs include product such as Amgen’s (Nasdaq: AMGN) Aranesp (darbepoetin) and Epogen (epoetin alfa) and Johnson & Johnson’s (NYSE: JNJ) Procrit (epoetin alfa), which have seen falling sales since the risk of strokes has been linked with their use in 2007. However, just earlier this month a US Food and Drug Administration advisory panel voted near unanimously that they should be retained on the market for anemia patients who do not yet require dialysis. However, the panel also recommended that more studies be undertaken to better explain which patients benefit from Aranesp and what dosing is ideal (The Pharma Letter October 19).