NICE technology appraisal guidance
Issued: May 2008

Epoetin alfa, epoetin beta and darbepoetin alfa for cancer treatment-induced anaemia

This is an extract from the guidance. The complete guidance is available at

1 Guidance

This guidance does not cover the use of erythropoietin analogues (epoetin alfa, epoetin beta and darbepoetin alfa) in the management of cancer-related anaemia that is not induced by cancer treatment (chemotherapy or radiotherapy).

During this appraisal the regulatory health authorities have conducted reviews into the safety of erythropoietin analogues. This guidance was produced taking the conclusions of those reviews into consideration, and should be read in conjunction with the reports published by the regulatory health authorities.

1.1 Erythropoietin analogues are not recommended for routine use in the management of cancer treatment-induced anaemia, except in the circumstances described below.

1.2 Erythropoietin analogues are recommended in combination with intravenous iron as an option for the management of cancer treatment-induced anaemia in women receiving platinum-based chemotherapy for ovarian cancer who have symptomatic anaemia with a haemoglobin level of 8 g/100 ml or lower. The use of erythropoietin analogues does not preclude the use of existing approaches to the management of anaemia, including blood transfusion where necessary.

1.3 Erythropoietin analogues in combination with intravenous iron may be considered for people who cannot be given blood transfusions and who have profound cancer treatment-related anaemia that is likely to have an impact on survival.

1.4 In the circumstances outlined in 1.2 and 1.3, the erythropoietin analogue with the lowest acquisition cost should be used.

1.5 People who are currently being treated with erythropoietin analogues for the management of cancer treatment-related anaemia but who do not fulfil the criteria in 1.2 and 1.3 should have the option to continue their therapy until they and their specialists consider it appropriate to stop.