Standards of care for anemia management in oncology: Focus on lung carcinoma

BACKGROUND. Anemia is common in patients with lung carcinoma, particularly among those undergoing platinum-based cytotoxic chemotherapy. Evidence is growing that anemia can have a profound impact on the patient's quality of life, often manifested as the patient's inability to function normally. METHODS. A literature review was conducted to provide a current picture of the incidence and impact of anemia in patients with lung carcinoma and the usage and limitations of current treatment. RESULTS. The incidence of anemia (a hemoglobin [Hb] level < 11g/dL) in lung carcinoma patients is approximately 50-60%, varying according to treatment regimen. However, despite evidence supporting the treatment of anemia, many clinicians only intervene when Hb levels fall below 8 g/dL. This may be because of a lack of awareness of the incidence and impact of anemia on cancer patients, but most likely is because of limitations of current treatment options (blood transfusion and recombinant human erythropoietin [epoetin-α]). Darbepoetin-α represents a new generation of erythropoiesis-stimulating proteins. Biochemically distinct from epoetin-α, darbepoetin-α has a greater sialic acid content and biologic half-life than epoetin-α, but stimulates erythropoiesis in the same manner. Clinical trials involving patients with cancer-related anemia have shown that darbepoetin-α has a threefold longer half-life than epoetin-α, which may allow less frequent dosing. The results from an ongoing clinical trial dedicated to testing the clinical benefits of darbepoetin-α in treating anemia in lung carcinoma patients will provide a valuable insight into its full potential in this setting. CONCLUSIONS. Anemia is common but is reported to be undertreated in patients with lung carcinoma. The introduction of darbepoetin-α into clinical practice may overcome some of the limitations of current treatments and facilitate improvement in the management of cancer-related anemia.