The development of erythropoietic agents in oncology

The erythropoietic agents have achieved a remarkable degree of success as products for the treatment of anaemia associated with cancer chemotherapy. Three agents, epoetin-alpha, epoetin-beta and darbepoetin-alpha, share this global market and have demonstrated similar efficacy and share similar shortcomings, primarily a lower magnitude of cost/benefit than is the case for the dialysis patient. The continued success of these agents will depend on their ability to address the issue of resistance to therapy in the cancer setting, with the most promising and practical initiatives including cotherapy with parenteral iron, and earlier initiation of therapy. Recently, safety issues have arisen with respect to these agents in the cancer setting, particularly focused on possible promotion of tumour progression. A large body of data suggests that these agents are safe when used in accordance with the package inserts. The data bearing upon these issues will be reviewed and three new agents entering clinical development will be described.