From the Guidelines
Aranesp is not indicated in patients with metastatic lung cancer under osimertinib with anemia, as the use of erythropoiesis-stimulating agents (ESAs) in cancer patients has been associated with potential tumor growth promotion and decreased survival. According to the ESMO clinical practice guidelines for the management of anaemia and iron deficiency in patients with cancer 1, ESA treatment is recommended in patients with symptomatic anaemia who receive chemotherapy (ChT) and present with an Hb level < 10 g/dL, as well as patients with asymptomatic anaemia who receive ChT and present with an Hb level < 8 g/dL. However, ESA treatment is not recommended in patients who are not on ChT 1. Since osimertinib is a targeted therapy and not a chemotherapy, the use of ESAs like Aranesp is not recommended. Instead, alternative management approaches should be considered, such as:
- Investigating and treating underlying causes of anemia (iron, B12, or folate deficiency)
- Considering blood transfusions for symptomatic anemia
- Dose modification of osimertinib if the anemia is treatment-related The potential risks of ESA therapy in this clinical scenario outweigh the benefits, and oncology guidelines generally discourage their routine use in patients with non-chemotherapy induced anemia or in patients receiving targeted therapies like osimertinib.
From the Research
Anemia Treatment in Metastatic Lung Cancer
- Aranesp (darbepoetin alfa) is an erythropoiesis-stimulating agent used to treat anemia in cancer patients, including those with metastatic lung cancer 2, 3, 4.
- The studies suggest that darbepoetin alfa can increase hemoglobin levels and reduce the need for transfusions in patients with chemotherapy-induced anemia, regardless of the type of cancer or chemotherapy regimen 3, 4.
- Osimertinib is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) used to treat advanced non-small cell lung cancer (NSCLC) with the EGFR T790M mutation 5.
- While there is no direct evidence on the use of Aranesp in metastatic lung cancer patients treated with osimertinib, the available studies suggest that darbepoetin alfa can be effective in treating anemia in cancer patients, including those with lung cancer 4, 6.
Indications for Aranesp
- Darbepoetin alfa is indicated for the treatment of anemia in patients with chemotherapy-induced anemia, with a hemoglobin level below 11 g/dl 2.
- The studies suggest that initiating treatment with darbepoetin alfa at hemoglobin levels above 10 g/dl can also result in substantial clinical benefits, including reduced transfusions and improved fatigue 4.
- However, the decision to treat anemia with darbepoetin alfa should be based on individual patient circumstances, including the severity of anemia, underlying cancer diagnosis, and ongoing treatments 2, 3.