The role of erythropoiesis-stimulating agents in contemporary clinical practice

Anaemia is one of the most significant factors that lead to deteriorated quality of life and limited therapeutic possibilities in cancer patients. When treating chronic anaemia associated with a neoplastic disease, one should consider RBC transfusion or the use of recombinant human erythropoiesis-stimulating agents (ESA). In 2007, following the golden era of ESA at the beginning of the 21st century, the American Food and Drug Administration (FDA) issued a number of warnings related to the use of ESAs. They concerned, i.e., the increased risk of cancer progression, probability of venous thromboembolism (VTE), and reduced overall survival times. That has led to a decrease in the use of erythropoiesis-stimulating agents in clinical practice. Results of the most recent studies and meta-analyses indicate the possibility of using ESA in patients undergoing palliative myelosuppressive chemotherapy, with haemoglobin levels < 10 g/dl, and without absolute iron deficiency, in order to avoid red cell concentrate transfusions, and with the hope to improve the patient’s quality of life.