Cancer-related anaemia management in the 21st century

Anaemia has a high prevalence and incidence in patients with cancer receiving chemotherapy and is associated with a range of symptoms, including fatigue, drowsiness, depression, dyspnoea, tachycardia and dizziness. Fatigue, in particular, exerts a considerable impact on patient quality of life, affecting 80-100% of patients receiving chemotherapy and, potentially, delaying treatment. Until recently, red blood cell transfusions were the mainstay of treatment for cancer-related anaemia. While effective in ameliorating symptoms, transfusions are associated with short-lived benefits and a risk of infections and disease transmission. The development of the erythropoiesis-stimulating agent (ESA), recombinant human erythropoietin (rHuEPO), resulted in a 50% reduction in the number of transfusions required in anaemic cancer patients receiving chemotherapy. The subsequently introduced rHuEPO analogue, darbepoetin alfa, stimulates erythropoiesis by the same mechanism as rHuEPO but is associated with a prolonged serum half-life, allowing extended dosing intervals and less frequent administration. With the introduction of a number of ESAs and a growing wealth of data concerning their indications, dosing regimens and safety, European cancer organizations have recently developed guidelines for their effective use in clinical practice.