Guidelines for using darbepoetin alfa in patients with chemotherapy-induced anemia

Anemia is an undertreated but common complication of cancer and is associated with debilitating symptoms that impair the patient's ability to perform daily functions of life. Treatment with darbepoetin alfa, a novel erythropoiesis-stimulating protein, is appropriate for chemotherapy-induced anemia. Guidelines on darbepoetin alfa therapy will assist clinicians in its appropriate application. Other causes of anemia in patients with cancer should be investigated and corrected before therapy with darbepoetin alfa is begun. Patients with hemoglobin levels below 11 g/dl are candidates for immediate therapy. For patients receiving chemotherapy who have declining hemoglobin levels but less severe anemia (< 12 but greater than or equal to 11 g/dl)1 the decision to treat immediately should be determined by the clinical circumstances. The preferred initial dosage for darbepoetin alfa is 200 mug every 2 weeks; 100 mug/week is an acceptable alternative. Dosages should be titrated to maintain hemoglobin levels at or near 12 g/dl. Reasons for failure to respond to darbepoetin alfa should be investigated before discontinuing therapy. Clinicians should consider discontinuing therapy if the hemoglobin level has not increased by 1 g/dl or more at 6-8 weeks after appropriate dosage adjustments or the number of red blood cell transfusions has not decreased.