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  • Publication # 13-RA009

Epoetin and darbepoetin reduce need for transfusions in cancer patients with anemia, but boost risk of blood clots

Comparative Effectiveness Research

An updated research review by AHRQ evaluated epoetin and darbepoetin—types of erythropoiesis-stimulating agents (ESAs)—in cancer patients with anemia who were receiving chemotherapy and/or radiotherapy treatment. The review finds that both epoetin and darbepoetin reduce the need for blood transfusions. 

These findings are consistent with a previous review on this topic completed in 2006. The review also finds that epoetin and darbepoetin are associated with an increased risk of thromboembolism (blood clots), and the use of these ESAs also increases the risk of death during and shortly after treatment. However, there is not enough available evidence to draw conclusions about the long-term effects of ESA treatment on survival.

Meanwhile, the quality-of-life benefits from treatments with ESAs (i.e., reduced fatigue from baseline levels) are small and are not considered clinically meaningful. Additional research is needed to determine whether dosing practices (immediate treatment at the start of chemotherapy or radiotherapy versus delaying treatment until hemoglobin falls below a certain level) and overall ESA exposure may influence treatment outcomes. Anemia, a deficiency in the concentration of hemoglobin-containing red blood cells, is prevalent among cancer patients, depending on the type of malignancy and treatment. Erythropoietin, a hormone produced in the kidney, is the major regulator of red blood cell production.

Commercially produced recombinant human erythropoietins have been extensively studied and used clinically for more than a decade to treat anemia in association with various diseases, reducing the need for transfusion. All ESAs increase the number of red blood cells within about 2 to 3 weeks when given to individuals with functioning erythropoiesis. 

These findings are available in the research review, Comparative Effectiveness of Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Treatment—Update at

Page last reviewed June 2013
Internet Citation: Epoetin and darbepoetin reduce need for transfusions in cancer patients with anemia, but boost risk of blood clots: Comparative Effectiveness Research. June 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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