The primary purpose is to provide useful guidelines to the American society of clinical oncology for EPOETIN and DARBEPOETIN use on cancer patients. The guidelines indicate the risk factors associated with agents like thromboembolic and darbepoetin.


EPOETIN refers to both Epoetin alfa and epoetin beta.


Patients with chemotherapy-associated anaemia with haemoglobin less than 10g/dl is recommended as an erythropoiesis-stimulating agent(ESA) to decrease transfusion and increase haemoglobin.

Depending upon the patient’s response, the ESA dosage should be provided. If there is no response after 6-8 weeks of ESA dosage, then as per FDA ESA therapy should be discontinued.

ESA therapy must be done very carefully with chemotherapy, as the risk of thromboembolic toxicity increases otherwise.

The survival chances decrease with the use of ESA therapy without chemotherapy.

FDA has issued a “black box” warning section on the package level of epoetin and darbepoetin. A baseline Hb level should also be mentioned for initiating ESA therapy in asymptomatic patients.


More clinical and laboratory research needs to be conducted to evaluate the clinical consequence of exposing with erythropoietin receptors. Research regarding ESA therapy, along with iron therapy needs to be done. The appropriate duration of treatment of ESA’s in MDS and its risks are yet to be found out.  With alternative dosing strategies, adverse events and comprehensive approaches should be assessed.